Publication

Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis

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Last modified
  • 06/25/2025
Type of Material
Authors
    Christina E Henson, University of OklahomaAhmad K v Abou-Foul, University of BirminghamDaniel J Morton, University of OklahomaLachlan McDowell, Peter MacCallum Cancer CentreSujith Baliga, affiliationJames Edward Bates, Emory UniversityAnna Lee, University of Texas, Houston, TexasPierluigi Bonomo, Azienda Ospedaliero-Universitaria CareggiPetr Szturz, University of LausannPaul Nankivell, University of BirminghamShao Hui Huang, University of TorontoWilliam M Lydiatt, Creighton UniversityBrian O’Sullivan, University of TorontoHisham Mehanna, University of Birmingham
Language
  • English
Date
  • 2023-09-20
Publisher
  • Frontiers
Publication Version
Copyright Statement
  • © 2023 Henson, Abou-Foul, Morton, McDowell, Baliga, Bates, Lee, Bonomo, Szturz, Nankivell, Huang, Lydiatt, O’Sullivan and Mehanna
License
Final Published Version (URL)
Title of Journal or Parent Work
Volume
  • 13
Start Page
  • 1263347
Grant/Funding Information
  • The authors declare financial support was received for the research, authorship, and/or publication of this article. Preparation of this manuscript was supported in part by the NCI Cancer Center Support Grant (P30CA225520) awarded to the University of Oklahoma Stephenson Cancer Center (SCC), and a grant from the Oklahoma Tobacco Settlement Endowment Trust (R23-02).
Abstract
  • Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
Author Notes
Keywords
Research Categories
  • Health Sciences, Oncology
  • Health Sciences, Pathology

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