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International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1)
R. Gupta, T. Fielder, M. Bal, SI. Chiosea, JE. Dahlstrom, A. Kakkar, K. Kiss, J. Laco, N. Mittal, S. Pasricha, S. Samra, N. Zidar, M. Bullock, R. Chernock, W. Faquin, SH. Huang, J. Yang, SO. Yoon
Language English Country United States
Document type Journal Article, Letter
- MeSH
- Squamous Cell Carcinoma of Head and Neck * pathology diagnosis MeSH
- Extranodal Extension * pathology MeSH
- Consensus MeSH
- Humans MeSH
- Head and Neck Neoplasms * pathology diagnosis MeSH
- Terminology as Topic * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Letter MeSH
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.
ACT Pathology Canberra Health Services Canberra Australia
Department of Mathematics and Statistics University of Sydney Sydney Australia
Department of Pathology All India Institute of Medical Sciences New Delhi Delhi India
Department of Pathology and Immunology Washington University School of Medicine Saint Louis MO USA
Department of Pathology Faculty of Medicine Dalhousie University Halifax Nova Scotia Canada
Department of Pathology NSW Health Pathology Westmead Hospital Sydney NSW Australia
Department of Pathology Rajiv Gandhi Cancer Institute and Research Centre New Delhi India
Department of Pathology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
Department of Pathology Tata Memorial Center Homi Bhabha National Institute Mumbai Maharashtra India
Department of Pathology University of Pittsburgh Pittsburgh Pennsylvania USA
Department of Pathology Yonsei University College of Medicine Severance Hospital Seoul Korea
Faculty of Medicine and Health University of Sydney Sydney NSW Australia
Institute of Pathology Faculty of Medicine University of Ljubljana Ljubljana Slovenia
NHMRC Center of Research Excellence for Applied Innovations in Oral Cancer Sydney NSW Australia
School of Medicine and Psychology ANU College of Science and Medicine Canberra Australia
References provided by Crossref.org
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