ESR Bridges: imaging and treatment of extranodal spread in head and neck cancer—a multidisciplinary view

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common cancer worldwide and causes diagnostic and therapeutic challenges [1]. The 8th edition of the TNM classification for HNSCC includes extranodal tumour extension in lymph node metastases (ENE) as a diagnostic criterion for N-staging because pathological ENE (p-ENE) has been recognised as one of the most important features indicating aggressive tumour behaviour, having a negative impact on disease-free and overall survival, and providing guidance for treatment [2, 3]. Current staging criteria apply ENE to SCC arising in all HN sites except nasopharyngeal cancer and high-risk human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) because available research has suggested that ENE has a lesser impact on prognosis and treatment of HPV+ OPSCC. Subsequent research has, however, indicated that ENE may be a key prognostic factor not only in OPSCC not associated with high-risk HPV (HPV − OPSCC) but also in HPV + OPSCC [4]. …