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Dankbaar et al. J Cancer Metastasis Treat 2021;7:56 Journal of Cancer
DOI: 10.20517/2394-4722.2021.112
Metastasis and Treatment

Review Open Access

Radiological assessment of extranodal extension in
patients with head and neck squamous cell

carcinoma

Jan W. Dankbaar, Frank A. Pameijer
Department of Radiology, University Medical Center Utrecht, Utrecht 3584CX, The Netherlands.
Correspondence to: Dr. Jan W. Dankbaar, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100,
Utrecht 3584CX, The Netherlands. E-mail: j.w.dankbaar@umcutrecht.nl

How to cite this article: Dankbaar JW, Pameijer FA. Radiological assessment of extranodal extension in patients with head and
neck squamous cell carcinoma. J Cancer Metastasis Treat 2021;7:56. https://dx.doi.org/10.20517/2394-4722.2021.112

Received: 7 May 2021 First Decision: 29 Jun 2021 Revised: 15 Jul 2021 Accepted: 23 Jul 2021 Published: 10 Sep 2021
Academic Editors: Lucio Miele, Remco R. de Bree Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
The prognosis of patients with head and neck squamous cell cancer (HNSCC) decreases with the presence of
extranodal extension (ENE) in lymph node metastases. Therefore, ENE was introduced in the 8th Edition TNM
Classification (TNM8) for Head and Neck Cancer as a staging variable in all HPV-negative HNSCC. Patients with
ENE may benefit from adjuvant or even primary chemotherapy and/or radiotherapy. There is a clear discrepancy
between the definition of clinical ENE and pathological ENE. In TNM8, the radiological evaluation of ENE only plays
a supportive role. Since not all patients with advanced disease will undergo a neck dissection, histologic proof of
ENE will not always be available. In these cases, it would be of great help to be able to accurately determine ENE
with radiological imaging. In this review, an update is given of the ability of radiological imaging to identify and
grade ENE.

Keywords: Head and neck cancer, extranodal extension, TNM8, radiology, CT, MR

EXTRANODAL EXTENSION
Locoregional recurrences and distant metastases account for the majority of treatment failures in head and
neck squamous cell cancer (HNSCC) . The presence of cervical lymph node metastases increased the
[1]
likelihood of locoregional recurrences and distant metastasis. It is therefore the most accurate prognostic

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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