ArticleOral oncology2015
Inter- and intra-observer variability in the classification of extracapsular extension in p16 positive oropharyngeal squamous cell carcinoma nodal metastases.
Article in Oral oncology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Biomarkers Associated With Extranodal Extension (ENE) in Oropharyngeal Squamous Cell Carcinoma (OPSCC): A Systematic Review.Head & neck · 2026Pooled it
- Histopathological Definitions of Extranodal Extension: A Systematic Review.Head and neck pathology · 2021Pooled it
- Correlation between imaging-detected and pathological extranodal extension in a randomised trial in Human Papillomavirus-positive oropharyngeal cancer.British journal of cancer · 2026Trial
- HPV-Associated Oropharyngeal Squamous Cell Carcinoma - Key Updates to the AJCC/UICC TNM9 Staging System.Annals of surgical oncology · 2026Article
- The extent of extranodal extension as a prognostic indicator in papillary thyroid cancer.Archives of endocrinology and metabolism · 2025Article
- Even microscopic extranodal extension has significant recurrent and metastatic potential in oral squamous cell carcinoma.European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025Article
- Preoperative Nodal Biopsy and Extranodal Extension in p16+ Oropharyngeal Squamous Cell Carcinoma.Laryngoscope investigative otolaryngology · 2025Article
- Observational
- International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1).Head and neck pathology · 2025Article
- Performance analysis of Leica Biosystems p16 monoclonal antibody in oropharyngeal squamous cell carcinoma.Diagnostic pathology · 2025Article
- [Advances in the diagnosis and prognosis of extranodal extension in head and neck squamous cell carcinoma].Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery · 2024Review
- Identifying primary tumor site of origin for liver metastases via a combination of handcrafted and deep learning features.The journal of pathology. Clinical research · 2024Article
- Inter- and Intrarater Reliability and Agreement Among Danish Head and Neck Pathologists Assessing Extranodal Extension in Lymph Node Metastases from Oropharyngeal Squamous Cell Carcinomas.Head and neck pathology · 2022Article
- Microscopic Extranodal Extension in HPV-Negative Head and Neck Cancer and the Role of Adjuvant Chemoradiation.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2021Article
- Update on oral and oropharyngeal cancer staging - International perspectives.World journal of otorhinolaryngology - head and neck surgery · 2020Review
- Article
- Pan-cancer diagnostic consensus through searching archival histopathology images using artificial intelligence.NPJ digital medicine · 2020Article
- Current Challenges in the Staging of Oral Cancer.Head and neck pathology · 2019Article
- Postoperative Treatment of Oropharyngeal Cancer in the Era of Human Papillomavirus.Current treatment options in oncology · 2019Review
- Reliability of deceased-donor procurement kidney biopsy images uploaded in United Network for Organ Sharing.Clinical transplantation · 2018Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveDiscern inter- and intra-observer variability in the classification of extracapsular extension (ECE) in p16+ oropharyngeal (OP) SCC comparing pathologists' own criteria versus those of a well-defined classification system.
methodsFive pathologists reviewed 50 digitally scanned nodal metastasis slides in three Rounds. Round One was by their own criteria as ECE present or absent, and Rounds Two and Three were with a defined ECE system: Grade 0 (no ECE), 0c (no ECE - thick capsule; no infiltration), 1 (ECE - cells beyond capsule), and 2 (soft tissue metastasis - cells in soft tissue without residual node). Round Three assessed intra-observer variability after an 8 month washout period.
resultsIn Round One, all five agreed on only 48% of cases (n=24). Fleiss's Kappa value was 0.508 (95% CI: 0.357-0.644). For Rounds Two and Three, Grades 0 and 0c and Grades 1 and 2 were separately grouped as ECE absent or present. In Round Two, all five agreed on 68% of cases (n=34). Fleiss' Kappa was 0.635 (95% CI: 0.472-0.783), indicating statistically significantly better agreement. In Round Three, all five agreed on 64% of cases (n=32) giving a Fleiss's Kappa of 0.639. Pathologists agreed with their prior reads in approximately 90% of cases (average n=45.4, range n=42-49), an average intra-observer Cohen's Kappa of 0.8 (range: 0.68-0.95). Inter- and intra-observer variability rates for classification of soft tissue metastasis (ECE2) were substantially worse.
conclusionThere is substantial inter-, and modest intra-, observer variability among head and neck pathologists for ECE in p16+ OPSCC, which is modestly improved by a defined system.
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