Springer Nature
Head and Neck Pathology
,  volume 19 ,  issue 1 ,  publication number 20

International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1)

Ruta Gupta 1, 2, 3, 4, 5
, 
Timothy Fielder 1
, 
Munita Bal 6
, 
Simion I. Chiosea 7
, 
Jane E. Dahlstrom 8, 9
, 
Aanchal Kakkar 10
, 
Katalin Kiss 11
, 
Jan Laco 12, 13
, 
Neha Mittal 6
, 
Sunil Pasricha 14
, 
Spinder Samra 15
, 
Nina Zidar 16
, 
Martin Bullock 17
, 
Rebecca Chernock 18
, 
William Faquin 19
, 
Shao Hui Huang 20
, 
Jean Yang 21
, 
Sun Och Yoon 22
1
 
2
 
3
 
NHMRC Center of Research Excellence for Applied Innovations in Oral Cancer, Sydney, Australia | 
4
 
5
 
6
 
7
 
8
 
ACT Pathology, Canberra Health Services, Canberra, Australia | 
9
 
School of Medicine and Psychology, ANU College of Science and Medicine, Canberra, Australia | 
10
 
11
 
12
 
13
 
14
 
15
 
16
 
17
 
18
 
19
 
20
 
21
 
22
 
Publication type: Journal Article
Publication date: 2025-02-07
Springer Nature
scimago Q1
wos Q1
SJR: 0.987
CiteScore: 6.1
Impact factor: 4.1
ISSN: 1936055X, 19360568
Abstract
Purpose

Extranodal 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.

Methods

An 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.

Results

ENE 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.

Conclusions

The consensus recommendations encompassing the definition of ENE, macroscopic and histologic examination of lymph nodes (LN) and practical guidelines for handling challenging cases are provided.

Found 
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Gupta R. et al. 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. 2025. Vol. 19. No. 1. 20
GOST all authors (up to 50) Copy
Gupta R., Fielder T., Bal M., Chiosea S. I., Dahlstrom J. E., Kakkar A., Kiss K., Laco J., Mittal N., Pasricha S., Samra S., Zidar N., Bullock M., Chernock R., Faquin W., Huang S. H., Yang J., Yoon S. O. 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. 2025. Vol. 19. No. 1. 20
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Cite this
RIS Copy
TY - JOUR
DO - 10.1007/s12105-025-01753-7
UR - https://link.springer.com/10.1007/s12105-025-01753-7
TI - International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1)
T2 - Head and Neck Pathology
AU - Gupta, Ruta
AU - Fielder, Timothy
AU - Bal, Munita
AU - Chiosea, Simion I.
AU - Dahlstrom, Jane E.
AU - Kakkar, Aanchal
AU - Kiss, Katalin
AU - Laco, Jan
AU - Mittal, Neha
AU - Pasricha, Sunil
AU - Samra, Spinder
AU - Zidar, Nina
AU - Bullock, Martin
AU - Chernock, Rebecca
AU - Faquin, William
AU - Huang, Shao Hui
AU - Yang, Jean
AU - Yoon, Sun Och
PY - 2025
DA - 2025/02/07
PB - Springer Nature
IS - 1
VL - 19
SN - 1936-055X
SN - 1936-0568
ER -
BibTex
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BibTex (up to 50 authors) Copy
@article{2025_Gupta,
author = {Ruta Gupta and Timothy Fielder and Munita Bal and Simion I. Chiosea and Jane E. Dahlstrom and Aanchal Kakkar and Katalin Kiss and Jan Laco and Neha Mittal and Sunil Pasricha and Spinder Samra and Nina Zidar and Martin Bullock and Rebecca Chernock and William Faquin and Shao Hui Huang and Jean Yang and Sun Och Yoon},
title = {International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1)},
journal = {Head and Neck Pathology},
year = {2025},
volume = {19},
publisher = {Springer Nature},
month = {feb},
url = {https://link.springer.com/10.1007/s12105-025-01753-7},
number = {1},
pages = {20},
doi = {10.1007/s12105-025-01753-7}
}