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

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.
Competing Interests: Declaration of interests HM is the director and a shareholder of Warwickshire Head and Neck Clinic; Chair of the Head and Neck Cancer International Group; past President of the British Association of Head and Neck Oncologists; has received honoraria from AstraZeneca; served on speakers bureau for Merck Sharpe & Dohme (MSD) and Sanofi Pasteur; has received research funding from GSK Biologicals, MSD, Sanofi Pasteur, GSK, and AstraZeneca; and has received travel and accommodation expenses from Sanofi, Pasteur, and MSD. CG received royalties from Elsevier for authoring and editing books and chapters for Elsevier. WML is the Chair of the American Joint Committee on Cancer (ninth version) Head and Neck Task Force. All other authors declare no competing interests.
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