ArticleHead and neck pathology2025
International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1).
Article in Head and neck pathology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 8 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 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
- Updated pan-tumor guidelines for neoadjuvant scoring of pathologic response: a joint SITC and INMC effort.Annals of oncology : official journal of the European Society for Medical Oncology · 2026Guideline
- Key Updates on the Version 9 AJCC/UICC Staging System for Salivary Gland Carcinoma.Annals of surgical oncology · 2026Article
- Limited Sensitivity of Ultrasound-Guided Fine-Needle Aspiration Cytology for Occult Nodal Metastases in Early-Stage Oral Squamous Cell Carcinoma.Head & neck · 2026Article
- Imaging-Detected Extranodal Extension in Head and Neck Cancer: Current Evidence, Standardized Grading, and Clinical Implications.Korean journal of radiology · 2026Review
- International Consensus Guidelines for Diagnostic Criteria and Checklist for Future Studies for Minimally Invasive Carcinoma ex Pleomorphic Adenoma: An HN CLEAR Initiative.Head and neck pathology · 2026Article
- Association Between Nutritional Status and Extranodal Extension of Lymph Node Metastases in Head and Neck Squamous Cell Cancers.Nutrients · 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
Corrections and comments
- Erratum issued
Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeExtranodal extension (ENE) increases the risk of recurrence and death in head and neck squamous cell carcinoma (HNSCC) patients and is an indication for treatment escalation. Histopathology forms the mainstay of diagnosing ENE. There is substantial variation in the diagnosis of ENE and related terminology. Harmonising the diagnostic criteria for ENE was identified as a priority by the Head and Neck Consensus Language for Ease of Reproducibility (HN CLEAR) Steering Committee and its global stakeholders.
methodsAn international working group including 16 head and neck pathologists from eight countries across five continents evaluated whole slide images of haematoxylin and eosin-stained sections depicting potential diagnostic problems through nine virtual meetings to develop consensus guidelines.
resultsENE should be diagnosed only when viable carcinoma extends through the primary lymph node (LN) capsule and directly interacts with the extranodal host environment with or without desmoplastic stromal response. Identifying the original LN capsule and reconstruction of its contour can assist in the detection and assessment of ENE. The term matting is recommended for confluence of two or more nodes due to histologically identifiable tumour extending from one LN to another. Matting constitutes major form of ENE. On the other hand, the terms fusion/adhesion/confluence/conglomeration and other synonyms of adhesion should be limited to confluence due to fibrosis or inflammation without histologically identifiable tumour between involved lymph nodes. Tumour extension along narrow needle tracks or spillage of cyst contents following an FNA do not constitute ENE.
conclusionsThe consensus recommendations encompassing the definition of ENE, macroscopic and histologic examination of lymph nodes (LN) and practical guidelines for handling challenging cases are provided.
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