Criteria for the diagnosis of extranodal extension detected on radiological imaging in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Christina Henson; Ahmad K Abou-Foul; Eugene Yu; Christine Glastonbury; Shao Hui Huang; Ann D King; William M Lydiatt; Lachlan McDowell; Alex A Nagelschneider; Paul C Nankivell; Brian O'Sullivan; Rhian Rhys; Youping Xiao; David Andrew; Jon T Asmussen; Francois Bidault; Jan W Dankbaar; Pim de Graaf; Eloisa S Gebrim; Chaosu Hu; Jianhui Ding; Tomonori Kanda; Jane Kim; Hirofumi Kuno; Santiago Medrano-Martorell; Nikolaos Oikonomopoulos; Julian Park-Nam Goh; Eloisa Santos-Armentia; Darius G Schafigh; Rathan M Subramaniam; Xin Cynthia Wu; Sue S Yom; Hisham Mehanna

doi:10.1016/S1470-2045(24)00066-4

Criteria for the diagnosis of extranodal extension detected on radiological imaging in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Lancet Oncol. 2024 Jul;25(7):e297-e307. doi: 10.1016/S1470-2045(24)00066-4.

Authors

Christina Henson¹, Ahmad K Abou-Foul², Eugene Yu³, Christine Glastonbury⁴, Shao Hui Huang⁵, Ann D King⁶, William M Lydiatt⁷, Lachlan McDowell⁸, Alex A Nagelschneider⁹, Paul C Nankivell², Brian O'Sullivan⁵, Rhian Rhys¹⁰, Youping Xiao¹¹, David Andrew¹², Jon T Asmussen¹³, Francois Bidault¹⁴, Jan W Dankbaar¹⁵, Pim de Graaf¹⁶, Eloisa S Gebrim¹⁷, Chaosu Hu¹⁸, Jianhui Ding¹⁹, Tomonori Kanda²⁰, Jane Kim²¹, Hirofumi Kuno²², Santiago Medrano-Martorell²³, Nikolaos Oikonomopoulos²⁴, Julian Park-Nam Goh²⁵, Eloisa Santos-Armentia²⁶, Darius G Schafigh²⁷, Rathan M Subramaniam²⁸, Xin Cynthia Wu²⁹, Sue S Yom³⁰, Hisham Mehanna³¹

Affiliations

¹ Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma Health Sciences Centre, Oklahoma City, OK, USA.
² Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
³ Neuroradiology and Head and Neck Imaging, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada; Mount Sinai Hospital and Women's College Hospital, Toronto, ON, Canada.
⁴ Otolaryngology-Head & Neck Surgery and Radiation Oncology, University of California, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
⁵ Department of Radiation Oncology and Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
⁶ The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong Special Administrative Region, China.
⁷ Department of Surgery, Nebraska Methodist Hospital and Methodist Women's Hospital, Creighton University, Omaha, NE, USA.
⁸ Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁹ Department of Radiology, Division of Neuroradiology, Mayo Clinic-Rochester, Rochester, MN, USA.
¹⁰ Radiology department, Royal Glamorgan Hospital, Caerdydd, Wales, UK.
¹¹ Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
¹² School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
¹³ Department of Radiology, Odense University Hospital, Odense, Denmark.
¹⁴ Department of Medical Imaging, Gustave Roussy Cancer Campus, and Multimodal Biomedical Imaging Laboratory (BioMaps), Paris-Saclay University, Villejuif, France.
¹⁵ Radiology department, University Medical Center, Utrecht, Netherlands.
¹⁶ Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, Netherlands.
¹⁷ Department of Radiology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil.
¹⁸ Department of Radiation Oncology, Fudan University Shanghai Cancer, Shanghai, China.
¹⁹ Department of Radiology, Fudan University Shanghai Cancer, Shanghai, China.
²⁰ Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan.
²¹ Radiology department, University of Hong Kong, Hong Kong Special Administrative Region, China.
²² Department of Diagnostic Radiology, National Cancer Center Hospital East, Kashiwa, Japan.
²³ Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
²⁴ Second Department of radiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
²⁵ Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
²⁶ Radiology Department, Povisa Hospital, Vigo, Spain.
²⁷ Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Germany.
²⁸ Department of Medicine, University of Otago Medical School, Dunedin, New Zealand; Department of Radiology, Duke University, Durham, NC, USA.
²⁹ Neuroradiology Division, University of California, San Francisco, CA, USA.
³⁰ Otolaryngology-Head & Neck Surgery and Radiation Oncology, University of California, San Francisco, CA, USA; Department of Radiation Oncology, University of California, San Francisco, CA, USA.
³¹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK. Electronic address: [email protected].

PMID: 38936388
DOI: 10.1016/S1470-2045(24)00066-4

Abstract

Extranodal extension of tumour on histopathology is known to be a negative prognostic factor in head and neck cancer. Compelling evidence suggests that extranodal extension detected on radiological imaging is also a negative prognostic factor. Furthermore, if imaging detected extranodal extension could be identified reliably before the start of treatment, it could be used to guide treatment selection, as patients might be better managed with non-surgical approaches to avoid the toxicity and cost of trimodality therapy (surgery, chemotherapy, and radiotherapy together). There are many aspects of imaging detected extranodal extension that remain unresolved or are without consensus, such as the criteria to best diagnose them and the associated terminology. The Head and Neck Cancer International Group conducted a five-round modified Delphi process with a group of 18 international radiology experts, representing 14 national clinical research groups. We generated consensus recommendations on the terminology and diagnostic criteria for imaging detected extranodal extension to harmonise clinical practice and research. These recommendations have been endorsed by 19 national and international organisations, representing 34 countries. We propose a new classification system to aid diagnosis, which was supported by most of the participating experts over existing systems, and which will require validation in the future. Additionally, we have created an online educational resource for grading imaging detected extranodal extensions.

Publication types

Review

MeSH terms

Consensus*
Delphi Technique
Extranodal Extension* / diagnostic imaging
Extranodal Extension* / pathology
Head and Neck Neoplasms* / diagnostic imaging
Head and Neck Neoplasms* / pathology
Head and Neck Neoplasms* / therapy
Humans
Prognosis
Terminology as Topic