SynthesisEuropean radiology2021
The diagnostic performance of CT and MRI for detecting extranodal extension in patients with head and neck squamous cell carcinoma: a systematic review and diagnostic meta-analysis.
Synthesis in European radiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 3 syntheses or guidelines pooled it, 61 citations in OpenAlex.
- Biomarkers Associated With Extranodal Extension (ENE) in Oropharyngeal Squamous Cell Carcinoma (OPSCC): A Systematic Review.Head & neck · 2026Pooled it
- Evidence-based guideline diagnosis, treatment, prevention and aftercare of oropharyngeal and hypopharyngeal carcinoma.German medical science : GMS e-journal · 2025Guideline
- Correlation between radiologic and pathologic extranodal extension in HPV-associated oropharyngeal cancer: Systematic review.Head & neck · 2022Pooled it
- Correlation between imaging-detected and pathological extranodal extension in a randomised trial in Human Papillomavirus-positive oropharyngeal cancer.British journal of cancer · 2026Trial
- Upfront Neck Dissection for Treatment Selection and Improvement in Quality of Life as a Novel Treatment Paradigm for Deintensification in HPV+ OPSCC.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024Trial
- Prediction of Residual Disease in Unresectable Head and Neck Squamous Cell Carcinoma After Concurrent Chemoradiotherapy.World journal of oncology · 2026Article
- Neoadjuvant triplet chemotherapy enables radiotherapy avoidance in human papillomavirus-associated oropharyngeal cancer: a multicentre Phase II trial.British journal of cancer · 2026Article
- HPV-associated Oropharyngeal Squamous Cell Carcinoma: An Imaging Framework for AJCC Version 9 TNM Staging.Radiology. Imaging cancer · 2026Review
- Article
- Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Review
- CT-based Extranodal Extension for Nodal Staging and Prognostic Stratification in Surgically Resectable Esophageal Squamous Cell Carcinoma.Radiology. Imaging cancer · 2026Observational
- Artificial Intelligence in Head and Neck Surgical Oncology: A State-of-the-Art Review.Journal of clinical medicine · 2026Review
- Does Smoking Influence Outcomes in Human Papillomavirus-Associated Oropharyngeal Cancer Treated with Transoral Robotic Surgery?Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026Article
- Imaging-Detected Extranodal Extension in Head and Neck Cancer: Current Evidence, Standardized Grading, and Clinical Implications.Korean journal of radiology · 2026Review
- The Diagnostic Gap Between Clinical and Pathological Extranodal Extension in Head and Neck Cancers: A 5-Year Nationwide Trend Analysis in Taiwan.Journal of personalized medicine · 2026Article
- Imaging-detected extranodal extension in head and neck cancer: clinical implications, diagnostic criteria, and the potential of photon-counting detector CT.Japanese journal of radiology · 2026Review
- [Clinical Significance of Extranodal Extension in Non-small Cell Lung Cancer: Current Status and Future Prospects].Zhongguo fei ai za zhi = Chinese journal of lung cancer · 2026Review
- A Panoramic View of Narrow Band Imaging in the Treatment of Head and Neck CancerCurrent medical imaging · 2026Review
- Human Papillomavirus-Positive Oropharyngeal Cancer: Clinical and Radiologic Characteristics.Journal of the Korean Society of Radiology · 2026Review
- Dual-energy CT for distinguishing between T3 and T4 stages of locally advanced nasopharyngeal carcinoma.Quantitative imaging in medicine and surgery · 2025Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo review the diagnostic performance of CT and MRI for detecting extranodal extension (ENE) in head and neck squamous cell carcinoma (HNSCC) patients.
methodsMEDLINE and EMBASE databases were searched up to October 7, 2019. Studies that evaluated the diagnostic performance of CT and/or MRI for detecting ENE in HNSCC patients were included. A 2 × 2 table was reconstructed for each study. Pooled sensitivity and specificity were calculated using the bivariate model and hierarchical summary receiver operating characteristic (HSROC) model. Subgroup analyses were performed according to HPV status and radiological features. Pooled correlation coefficient for interobserver agreement was calculated.
resultsTwenty-two studies including 2478 patients were included. The pooled sensitivity and specificity for detecting ENE were 73% (95% CI, 62-82%) and 83% (95% CI, 75-89%), respectively, for CT, and 60% (95% CI, 49-70%) and 96% (95% CI, 85-99%), respectively, for MRI. There was substantial heterogeneity for both CT and MRI. A threshold effect was present for MRI. On subgroup analysis, the pooled specificity of CT was significantly lower in patients with HPV+ OPSCC than in patients with HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%; p = 0.01). Central node necrosis showed significantly higher pooled sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed significantly higher pooled specificity (94% vs. 65%; p = 0.03). The pooled correlation coefficient was 0.72 (95% CI, 0.60-0.81).
conclusionBoth CT and MRI show reasonable diagnostic performance for detecting ENE in HNSCC patients and interobserver agreement was substantial. KEY POINTS: • Pooled sensitivity and specificity were 73% and 83% for CT and 60% and 96% for MRI without significant difference. • Pooled specificity was lower for HPV+ OPSCC than for HPV‑ oral cavity cancer or all HNSCC (74% vs. 87%, p = 0.01), likely due to central node necrosis. • Central node necrosis showed higher sensitivity (81% vs. 51%; p = 0.02), while infiltration of adjacent planes showed higher specificity (94% vs. 65%; p = 0.03).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.