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J Cancer Metastasis Treat 2021;7:[Accepted].10.20517/2394-4722.2021.112@The Author(s) 2021
Accepted Manuscript
Open AccessReview

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

Correspondence Address: Dr. Jan W. Dankbaar, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584CX, The Netherlands. E-mail:; ORCID: 0000-0003-4646-9587


© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (, which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.


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.

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:[Accept].

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