Evaluating Radiologic Extranodal Extension in HPV-Positive Oropharyngeal Cancer: Accuracy, Prognostic Value, and Clinical Implications from a Multinational Real-World Study

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This large-scale international study assessed the accuracy and prognostic significance of radiologic extranodal extension (iENE) in HPV-mediated oropharyngeal cancer (HPV+ OPC). Key findings include:

• iENE demonstrated modest sensitivity (44.5%) but high specificity (87.6%) with substantial intercenter variability.
• Combining CT and MRI imaging significantly improved diagnostic accuracy, enhancing sensitivity to 84.6% and specificity to 94.5%.
• Specialist head and neck radiologists yielded better specificity compared to nonspecialists.
• iENE positivity was not an independent predictor of overall or disease-free survival in multivariable analyses.
• Current TNM staging modifications incorporating iENE showed limited improvement in prognostic power.