Hi Marg

Decision to do a ND ultimately lies with the surgeon in consultation with the team and the patient.

The NCCN guidelines state this before describing which level or grouping of lymph nodes should be removed during ND should this be the chosen path. Lymph nodes are grouped in 5 "levels" (I-V). Years ago, they whipped all the nodes out(radical ND) but nowadays they have figured out which nodes and levels are likely to be involved with which location (and maybe size) of the primary tumour, so can dissect only those levels (selective ND). No dissection and reliance on chemo or rads to mop up is also a reasonable option and is more often considered today as we understand more and develop the technology and skills to better target the tumour and minimise the after effects of treatment.

The five levels of lymph nodes are expressed as roman numerals (I-V) and are easily confused with staging (I-IV)which is also expressed this way. Could this be what you read in the guidelines?

I agree Kelly's staging and T3 don't quite add up but this is not uncommon and would make no difference to treatment.