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Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning

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Abstract

Extranodal extension (ENE) is a significant prognostic factor in p16-negative head and neck squamous-cell carcinoma and is classified as N3b by the American Joint Committee on Cancer 8th edition. While most previous radiological studies have focused on the diagnostic performance of pathological ENE, radiologists should be able to provide more clinically relevant information on this entity. The purpose of this article is to review the clinical implications of ENE, to describe key imaging features of ENE with clinical and histopathological correlations and to discuss evaluation of ENE for clinical staging, treatment planning, and predicting the response to treatment. First, we discuss the basics of ENE, including definitions of pathological and clinical ENE and its association with imaging findings. Second, we describe the ENE extension pattern at each location according to level system. The crucial structures determining the choice of treatment include the deep fascia in the deep cervical layer, internal and common carotid arteries, and mediastinal structures. Invasion of the muscles, internal jugular vein, nerves, or mandible also affect the surgical procedure. Finally, we discuss assessment of nodal metastasis after chemoradiotherapy.

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Acknowledgements

This work was supported by JSPS KAKENHI Grant Numbers JP19K17252 and Canon medical systems.

Funding

This article was supported by JSPS KAKENHI Grant Numbers JP19K17252 and Canon Medical systems. This article was presented in part at the 104th annual meeting of the Radiological Society of North America (RSNA) in Chicago, 2018. It received a Magna Cum Laude for educational exhibit.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Takashi Hiyama, Hirofumi Kuno, Kotaro Sekiya, Shioto Oda & Tatsushi Kobayashi

  2. Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Takahiko Nagaki & Ryuichi Hayashi

  3. Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Satoshi Fujii

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  1. Takashi Hiyama
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Correspondence to Takashi Hiyama.

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Tatsushi Kobayashi has funding from Canon Medical Systems. The other authors declare that they have no conflict of interest.

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Hiyama, T., Kuno, H., Nagaki, T. et al. Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol 38, 489–506 (2020). https://doi.org/10.1007/s11604-020-00929-1

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