This code system http://hl7.org/fhir/us/breast-radiology/CodeSystem/breastrad-LymphNodeQualifiersCS defines the following codes:
| Code | Display | Definition |
| LevelILymphNode | Level I is the bottom level, below the lower edge of the pectoralis minor muscle. | Level I is the bottom level, below the lower edge of the pectoralis minor muscle. |
| LevelIILymphNode | Level II is lying underneath the pectoralis minor muscle. | Level II is lying underneath the pectoralis minor muscle. |
| LevelIIILymphNode | Level III is above the pectoralis minor muscle. | Level III is above the pectoralis minor muscle. |
| NormalLymphNode | Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal.7,8 Little information exists to suggest that a specific diagnosis can be based on node size. | Nodes are generally considered to be normal if they are up to 1 cm in diameter; however, some authors suggest that epitrochlear nodes larger than 0.5 cm or inguinal nodes larger than 1.5 cm should be considered abnormal.7,8 Little information exists to suggest that a specific diagnosis can be based on node size. |
| WithEccentricThickeningCortex | Eccentric en- largement with focal thickening of the cortex is a strong indicator of malignant transformation. Indentation of the hilum, and especially ob- literation of the hilum, is highly suggestive of malignancy (4). ... Enlargement of lymph nodes can be due to a variety of benign and malignant causes. | Eccentric en- largement with focal thickening of the cortex is a strong indicator of malignant transformation. Indentation of the hilum, and especially ob- literation of the hilum, is highly suggestive of malignancy (4). ... Enlargement of lymph nodes can be due to a variety of benign and malignant causes. |
| WithEnlargementOfNode | When cancer has spread to the axillary lymph nodes, the nodes may feel enlarged, or there may be a noticeable lump. A breast cancer prognosis is better when the cancer is only in the breast, and the lymph nodes are not affected. Most people who have enlarged axillary lymph nodes do not have cancer at all. | When cancer has spread to the axillary lymph nodes, the nodes may feel enlarged, or there may be a noticeable lump. A breast cancer prognosis is better when the cancer is only in the breast, and the lymph nodes are not affected. Most people who have enlarged axillary lymph nodes do not have cancer at all. |
| WithFocalThickeningCortex | Currently many studies utilize cortical thickening and hilum absence as criteria for definition of the risk for metastasis(11,12-16). ... Metastatic deposits accumulate in the lymph node peripheral area, causing enlargement of the cortex, usually focal (at early stages), or uniform. | Currently many studies utilize cortical thickening and hilum absence as criteria for definition of the risk for metastasis(11,12-16). ... Metastatic deposits accumulate in the lymph node peripheral area, causing enlargement of the cortex, usually focal (at early stages), or uniform. |
| WithUniformThickeningCortex | Lymph node cortical thickness and uniformity are the most important criteria for distinguishing between normal and abnormal nodes. Normal lymph nodes have a reniform shape, a uniformly hypoechoic cortex with a maximal thickness of 3 mm, smooth margins, and a central fatty hilum (Fig 1). Findings of cortical thickness in excess of 3 mm, eccentric thickening, irregular margins, and encroachment on or displacement of the fatty hilum are suggestive of a pathologic process. | Lymph node cortical thickness and uniformity are the most important criteria for distinguishing between normal and abnormal nodes. Normal lymph nodes have a reniform shape, a uniformly hypoechoic cortex with a maximal thickness of 3 mm, smooth margins, and a central fatty hilum (Fig 1). Findings of cortical thickness in excess of 3 mm, eccentric thickening, irregular margins, and encroachment on or displacement of the fatty hilum are suggestive of a pathologic process. |
