ArticleEuropean radiology2023
Diagnostic performance of computed tomography features in detecting oropharyngeal squamous cell carcinoma extranodal extension.
Article in European radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Machine Learning to Predict Extranodal Extension in Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis.The Laryngoscope · 2026Pooled it
- HPV-associated Oropharyngeal Squamous Cell Carcinoma: An Imaging Framework for AJCC Version 9 TNM Staging.Radiology. Imaging cancer · 2026Review
- Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Review
- Imaging-Detected Extranodal Extension in Head and Neck Cancer: Current Evidence, Standardized Grading, and Clinical Implications.Korean journal of radiology · 2026Review
- Automated Lymph Node and Extranodal Extension Assessment Improves Risk Stratification in Oropharyngeal Carcinoma.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2026Article
- Human Papillomavirus-Positive Oropharyngeal Cancer: Clinical and Radiologic Characteristics.Journal of the Korean Society of Radiology · 2026Review
- Artificial Intelligence Model for Imaging-Based Extranodal Extension Detection and Outcome Prediction in Human Papillomavirus-Positive Oropharyngeal Cancer.JAMA otolaryngology-- head & neck surgery · 2026Article
- Imaging-Detected Extranodal Extension in Head and Neck Cancer: Clinical Significance and a Standardized Imaging Assessment.Journal of the Korean Society of Radiology · 2026Review
- Oropharyngeal Carcinoma Presenting as a Large Cervical Mass With Impending Airway Obstruction.Cureus · 2025Article
- Observational
- Predicting Extranodal Extension with Preoperative Contrast-enhanced CT in Patients with Oropharyngeal Squamous Cell Carcinoma.Radiology. Imaging cancer · 2025Article
- Article
- Prediction of extranodal extension in head and neck squamous cell carcinoma by CT images using an evolutionary learning model.Cancer imaging : the official publication of the International Cancer Imaging Society · 2023Article
Corrections and comments
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Authors and funding
17 authors at 6 institutions in 2 countries.
Funding
Abstract
objectivesAccurate pre-treatment imaging determination of extranodal extension (ENE) could facilitate the selection of appropriate initial therapy for HPV-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). Small studies have associated 7 CT features with ENE with varied results and agreement. This article seeks to determine the replicable diagnostic performance of these CT features for ENE.
methodsFive expert academic head/neck neuroradiologists from 5 institutions evaluate a single academic cancer center cohort of 75 consecutive HPV + OPSCC patients. In a web-based virtual laboratory for imaging research and education, the experts performed training on 7 published CT features associated with ENE and then independently identified the "single most (if any) suspicious" lymph node and presence/absence of each of the features. Inter-rater agreement was assessed using percentage agreement, Gwet's AC1, and Fleiss' kappa. Sensitivity, specificity, and positive and negative predictive values were calculated for each CT feature based on histologic ENE.
resultsAll 5 raters identified the same node in 52 cases (69%). In 15 cases (20%), at least one rater selected a node and at least one rater did not. In 8 cases (11%), all raters selected a node, but at least one rater selected a different node. Percentage agreement and Gwet's AC1 coefficients were > 0.80 for lesion identification, matted/conglomerated nodes, and central necrosis. Fleiss' kappa was always < 0.6. CT sensitivity for histologically confirmed ENE ranged 0.18-0.94, specificity 0.41-0.88, PPV 0.26-0.36, and NPV 0.78-0.96.
conclusionsPreviously described CT features appear to have poor reproducibility among expert head/neck neuroradiologists and poor predictive value for histologic ENE. KEY POINTS: • Previously described CT imaging features appear to have poor reproducibility among expert head and neck subspecialized neuroradiologists as well as poor predictive value for histologic ENE. • Although it may still be appropriate to comment on the presence or absence of these CT features in imaging reports, the evidence indicates that caution is warranted when incorporating these features into clinical decision-making regarding the likelihood of ENE.
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