[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-370768-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-370768-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","imaging-of-extranodal-extension-why-is-it-important-in-head-and-neck-cancer","Imaging of Extranodal Extension - Why Is It Important in Head and Neck Cancer","","Imaging-based assessment of extranodal extension (iENE) is critical for managing metastatic nodes in head and neck cancer, guiding both surgical and radiotherapy planning across early detection of small otherwise-normal metastases and later identification of invasion into adjacent structures. Emerging prognostic indicators of iENE are informing treatment planning, prognosis, and staging, supported by international consensus grading and the broad coverage of imaging compared with pathology. The review compares iENE with pathological assessment and highlights advantages, limitations, and knowledge gaps.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/imaging-of-extranodal-extension-why-is-it-important-in-head-and-neck-cancer/370768/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/imaging-of-extranodal-extension-why-is-it-important-in-head-and-neck-cancer/370768.png","ImageObject",300,407,{"name":42,"@type":43},"Stanford","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-23",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",8,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What does imaging-based extranodal extension (iENE) evaluate in head and neck cancer?","Question",{"text":63,"@type":64},"iENE detects metastatic nodes and maps the extent of invasion into adjacent tissues. It provides a basis for treatment planning by indicating whether disease extends beyond nodal boundaries.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why is iENE important when pathological assessment is not available?",{"text":68,"@type":64},"iENE is especially relevant for cancers primarily treated with (chemo)radiotherapy, where post-surgery pathological assessment (pENE) may not be available. Imaging can then guide decisions using consistently applied criteria.",{"name":70,"@type":61,"acceptedAnswer":71},"How is iENE graded in current consensus standards?",{"text":72,"@type":64},"Consensus grading standardizes iENE into four grades: grade 0 (irregular margins), grade 1 (perinodal fat invasion), grade 2 (nodal matting), and grade 3 (advanced invasion into adjacent structures).","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},370768,1790546665,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":112},2336477552062,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","REVIEW  \nImaging of extranodal extension: why is it important in head and neck cancer?  \nA. D. King1 ∗, Y. M. Tsang1, H. S. Leung1, R. G. Yoon2, A. C. Vlantis3, K. C. W. Wong4, J. H. Lee5 & Q. Y. H. Ai1 , 6  \n1Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; 2Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea; 3Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong; 4Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; 5Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea; 6Department of Diagnostic Radiology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China  \nAvailable online xxx  \nThe assessment of extranodal extension by imaging (iENE) is important in the management of patients with metastatic nodes from head and neck cancer (HNC) . Over many decades iENE has guided surgical and radiotherapy planning using both early iENE, to detect small metastatic nodes that otherwise appear normal on imaging, and late iENE, to detect invasion into adjacent structures. Currently, new prognostic indicators of iENE are under a spotlight for treatment planning, prognosis and staging. This is aided by ongoing international interdisciplinary consensus building on iENE grading for prognosis and by the advantages of imaging over pathological assessment (pENE), which include coverage of all nodal groups in all patients irrespective of age, cancer stage or treatment. These advantages are especially relevant to those cancers treated primarily by (chemo)radiotherapy, such as viral-related human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinomas and Epstein—Barr virus-positive nasopharyngeal carcinomas.  \nEvidence for the role of iENE as an indicator of poor prognosis is accumulating. Inclusion of iENE in the N category of the upcoming American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) HNC staging guidelines is under consideration and has already been included in the latest AJCC ninth version of cancer staging guideline for nasopharyngeal carcinoma. New indications for iENE in treatment planning are under evaluation in areas such as the selection of HPV-positive oropharyngeal squamous cell carcinoma for treatment de-escalation. However, there are many gaps in our knowledge of iENE, which are a concern in multidisciplinary meetings because of their potential effect on decisions regarding disease management. New indications for iENE in the management of HNC patients are an exciting advance but more research is needed for it to reach its full potential. Key words: extranodal extension, head and neck cancer, imaging, review  \nINTRODUCTION  \nThe detection of extranodal extension by imaging (iENE) isone of the imaging criteria used to diagnose metastatic nodes from head and neck cancer (HNC) and the extent ofiENE is used to map invasion of adjacent tissues. Currently iENE is under a spotlight because of its new indications for treatment planning, prognosis and staging in cancers treated with (chemo)radiotherapy, where pathological assessment (pENE) after surgery is not available. This is related primarily to viral-related cancers, namely human papillomavirus  \n*Correspondence to: Prof. Ann D. King, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.  \nTel: +852-35052290 [E-mail:](E-mail: King2015@cuhk.edu.hk)[ King2015@cuhk.edu.hk](E-mail: King2015@cuhk.edu.hk) (A. D. King).  \n2059-7029/© 2025 The Authors. Published by Elsevier Ltd on behalf of European Society for Medical Oncology. This is an open access article under the CC BY-NC-ND license ([http://","cbCaithwISF62l9A","https://ap.wps.com/l/cbCaithwISF62l9A","pdf",4339255,12,"English","# INTRODUCTION\n# IMAGING ENE: CRITERIA AND IMAGING MODALITIES\n## iENE criteria and features on CT and MRI\n## Consensus grading for iENE","[{\"question\":\"What does imaging-based extranodal extension (iENE) evaluate in head and neck cancer?\",\"answer\":\"iENE detects metastatic nodes and maps the extent of invasion into adjacent tissues. It provides a basis for treatment planning by indicating whether disease extends beyond nodal boundaries.\"},{\"question\":\"Why is iENE important when pathological assessment is not available?\",\"answer\":\"iENE is especially relevant for cancers primarily treated with (chemo)radiotherapy, where post-surgery pathological assessment (pENE) may not be available. Imaging can then guide decisions using consistently applied criteria.\"},{\"question\":\"How is iENE graded in current consensus standards?\",\"answer\":\"Consensus grading standardizes iENE into four grades: grade 0 (irregular margins), grade 1 (perinodal fat invasion), grade 2 (nodal matting), and grade 3 (advanced invasion into adjacent structures).\"}]","Imaging of Extranodal Extension - Why Is It Important in Head and Neck Cancer | PDF",1790190275]