Standardised definitions and diagnostic criteria for extranodal extension detected on histopathological examination in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Ahmad K Abou-Foul¹, Christina Henson², Rebecca D Chernock³, Shao Hui Huang⁴, William M Lydiatt⁵, Lachlan McDowell⁶, Brian O'Sullivan⁴, Bayardo Perez-Ordonez⁷, Max Robinson⁸, Paul C Nankivell¹, Elena Ruiz-Bravo⁹, Simion I Chiosea¹⁰, Tina M Green¹¹, Keith D Hunter¹², Jacqueline Sg Hwang¹³, Senada Koljenovic¹⁴, Sjors A Koppes¹⁵, Stine R Larsen¹⁶, Anthony W I Lo¹⁷, Valérie Costes-Martineau¹⁸, Neha Mittal¹⁹, Taisuke Mori²⁰, Toshitaka Nagao²¹, Ioannis G Panayiotides²², Clóvis A L Pinto²³, Kathrin Scheckenbach²⁴, Raja R Seethala¹⁰, Benedicte P Ulhøi²⁵, Andrea Vingiani²⁶, Yan Zhang²⁷, Sue S Yom²⁸, Hisham Mehanna²⁹

Affiliations

¹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
² Department of Radiation Oncology, College of Medicine, University of Oklahoma Health Sciences Centre, Oklahoma City, OK, USA.
³ Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
⁵ Department of Surgery, Nebraska Methodist Hospital and Methodist Women's Hospital, Creighton University, Omaha, NE, USA.
⁶ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
⁷ Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada.
⁸ School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
⁹ Department of Pathology, University Hospital La Paz, Madrid, Spain.
¹⁰ Department of Pathology, Presbyterian University Hospital, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
¹¹ Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹² Institute of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
¹³ Department of Anatomical Pathology, Singapore General Hospital, Singapore.
¹⁴ Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
¹⁵ Department of Pathology, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹⁶ Department of Pathology, Odense University Hospital, Odense, Denmark.
¹⁷ Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong.
¹⁸ Department of Pathology, Hospital Gui de Chauliac, Montpellier, France.
¹⁹ Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, India.
²⁰ National Cancer Centre Hospital, Tokyo, Japan.
²¹ Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
²² Department of Pathology, National and Kapodistrian University of Athens Medical School, Athens, Greece.
²³ Department of Pathological Anatomy, AC Camargo Cancer Centre, São Paulo, SP, Brazil.
²⁴ Department of Otorhinolaryngology and Head and Neck Surgery, Heinrich Heine University, Düsseldorf, Germany.
²⁵ Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
²⁶ Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
²⁷ Department of Pathology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
²⁸ Department of Radiation Oncology, University of California, San Francisco, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
²⁹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK. Electronic address: h.mehanna@bham.ac.uk.

PMID: 38936387
DOI: 10.1016/S1470-2045(24)00143-8

Review

Standardised definitions and diagnostic criteria for extranodal extension detected on histopathological examination in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Ahmad K Abou-Foul et al. Lancet Oncol. 2024 Jul.

. 2024 Jul;25(7):e286-e296.

doi: 10.1016/S1470-2045(24)00143-8.

Authors

Affiliations

¹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
² Department of Radiation Oncology, College of Medicine, University of Oklahoma Health Sciences Centre, Oklahoma City, OK, USA.
³ Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
⁵ Department of Surgery, Nebraska Methodist Hospital and Methodist Women's Hospital, Creighton University, Omaha, NE, USA.
⁶ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
⁷ Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada.
⁸ School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
⁹ Department of Pathology, University Hospital La Paz, Madrid, Spain.
¹⁰ Department of Pathology, Presbyterian University Hospital, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA.
¹¹ Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹² Institute of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
¹³ Department of Anatomical Pathology, Singapore General Hospital, Singapore.
¹⁴ Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
¹⁵ Department of Pathology, Erasmus University Medical Centre, Rotterdam, Netherlands.
¹⁶ Department of Pathology, Odense University Hospital, Odense, Denmark.
¹⁷ Division of Anatomical Pathology, Queen Mary Hospital, Hong Kong.
¹⁸ Department of Pathology, Hospital Gui de Chauliac, Montpellier, France.
¹⁹ Department of Surgical Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, India.
²⁰ National Cancer Centre Hospital, Tokyo, Japan.
²¹ Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan.
²² Department of Pathology, National and Kapodistrian University of Athens Medical School, Athens, Greece.
²³ Department of Pathological Anatomy, AC Camargo Cancer Centre, São Paulo, SP, Brazil.
²⁴ Department of Otorhinolaryngology and Head and Neck Surgery, Heinrich Heine University, Düsseldorf, Germany.
²⁵ Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
²⁶ Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
²⁷ Department of Pathology, Fudan University Shanghai Cancer Centre, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
²⁸ Department of Radiation Oncology, University of California, San Francisco, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
²⁹ Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK. Electronic address: h.mehanna@bham.ac.uk.

PMID: 38936387
DOI: 10.1016/S1470-2045(24)00143-8

Abstract

Detection of extranodal extension on histopathology in surgically treated head and neck squamous cell carcinoma indicates poor prognosis. However, there is no consensus on the diagnostic criteria, interpretation, and reporting of histology detected extranodal extension, which has contributed to conflicting evidence in the literature, and likely clinical inconsistency. The Head and Neck Cancer International Group conducted a three-round modified Delphi process with a group of 19 international pathology experts representing 15 national clinical research groups to generate consensus recommendations for histology detected extranodal extension diagnostic criteria. The expert panel strongly agreed on terminology and diagnostic features for histology detected extranodal extension and soft tissue metastasis. Moreover, the panel reached consensus on reporting of histology detected extranodal extension and on nodal sampling. These consensus recommendations, endorsed by 19 organisations representing 34 countries, are a crucial development towards standardised diagnosis and reporting of histology detected extranodal extension, and more accurate data collection and analysis.

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Conflict of interest statement

Declaration of interests HM is the Director and a shareholder of Warwickshire Head and Neck Clinic; chair of the Head and Neck Cancer International Group; past president of the British Association of Head and Neck Oncologists; reports receiving honoraria from AstraZeneca; is on the Speaker's Bureau for Merck Sharpe Dohme (MSD), Sanofi Pasteur, and Merck; received funding from GSK Biologicals, MSD, Sanofi Pasteur, GSK, and AstraZeneca; and received travel accommodation expenses from Sanofi Pasteur, MSD, and Merck. WML is the chair of American Joint Committee on Cancer 9th Version head and neck task force. RDC is a member of a steering committee for a phase 3 clinical trial of neoadjuvant pembrolizumab sponsored by Merck and also has a non-financial relationship with Caris Life Sciences as a member of their Precision Oncology Alliance. All other authors declare no competing interests.

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Standardised definitions and diagnostic criteria for extranodal extension detected on histopathological examination in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Affiliations

Standardised definitions and diagnostic criteria for extranodal extension detected on histopathological examination in head and neck cancer: Head and Neck Cancer International Group consensus recommendations

Authors

Affiliations

Abstract

Conflict of interest statement

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MeSH terms

LinkOut - more resources

Full Text Sources

Medical