International consensus recommendations and alignment of terminology for the histopathological diagnosis of extranodal extension in head and neck squamous cell carcinoma: an HN-CLEAR initiative - 23/12/25
Doi : 10.1016/S1470-2045(25)00535-2
Ruta Gupta, ProfFRCPA a, p, Timothy Fielder, FRCPA a, Munita Bal, ProfMD c, Simion I Chiosea, ProfMD d, Jane E Dahlstrom, ProfFRCPA f, g, Aanchal Kakkar, MD h, Katalin Kiss, MD i, Jan Laco, ProfMD j, Neha Mittal, MD b, Sunil Pasricha, MD k, Spinder Samra, FRCPA n, p, Nina Zidar, ProfMD q, Martin Bullock, ProfMD r, Rebecca Chernock, ProfMD s, William Faquin, ProfMD t, Mary S Richardson, ProfMD u, D Neil Hayes, ProfMD v, Shao Hui Huang, MD w, Jean Yang, ProfPhD o, Ziyad Alsugair, MD x, Nazim Benzerdjeb, MD x, Shaun Chou, FRCPA n, Caroline Cooper, FRCPA y, Katarina Dimnik, MD q, Rimlee Dutta, MD h, Ricardo Santiago Gomez, ProfPhD z, Juan C Hernandez-Prera, MD aa, Meenakshi Kamboj, DNB l, Tina Klitmøller Agander, MD i, Ankur Kumar, MD m, Jenny T H Lee, MD ac, Diana M Bell, ProfMD e, Toshitaka Nagao, ProfMD ad, Masato Nakaguro, MD ae, Timothy Onyuma, FRCPath af, Ji Hyun Park, MD ag, Jin Woo Park, MD ag, Asawari Patil, MD b, Miroslav Podhola, MD j, Swapnil Rane, MD b, Sean A Rasmussen, MD r, Tomáš Rozkoš, MD j, Prarthna Shah, MD b, Divakar Sharma, MD ah, Stefi Stefi, FRCPA n, Antje Stubsgaard, MD i, Ana Cristina Tetzner, DDS z, Bruce M Wenig, ProfMD ab, William H Westra, ProfMD ai, Laura Wise, FRCPA f, Sun Och Yoon, ProfMD ag, ⁎ 
on the behalf of the
on the behalf of the
HN-CLEAR steering committee and clinical advisory group
Justin A Bishop, ProfessorMD aj, Keith D Hunter, ProfessorFRCPath ak, Kelly Magliocca, MD al, Raja R Seethala, ProfessorMD am, Lester D R Thompson, MD an, Ilan Weinreb, MD ao, Peter Angelos, ProfessorMD ap, Beth Beadle, ProfessorMD aq, R Bryan Bell, MD ar, Jonathan R Clark, ProfessorFRACS as, Robert Ferris, ProfessorMD at, Rahul Ladwa, FRACS au, James S Lewis, MD av
aj UT Southwestern Medical Center, Dallas, TX, USA
ak Liverpool Head and Neck Centre, University of Liverpool, Liverpool, UK
al Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
am Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
an Head and Neck Pathology Consultations, Woodland Hills, California, USA
ao Anatomic Pathology, University Health Network and University of Toronto Laboratory Medicine Program, Toronto, Ontario, Canada
ap Endocrine Surgery, University of Chicago, Chicago, Illinois, USA
aq Radiation Oncology, Stanford University, Palo Alto, California, USA
ar Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
as Head and neck Surgery, Chris O’Brien Lifehouse, Royal Prince Alfred Institute of Academic Surgery, The University of Sydney, Sydney, NSW Australia
at University of Pittsburgh Medical Center, Head and Neck Surgery, Pittsburgh, PA, USA
au Medical Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
av Department of Pathology, Mayo Clinic, Phoenix, Arizona, USA
a Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
b Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
c Head-Neck and Gastrointestinal Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
d Department of Pathology, University of Pittsburgh Medical Center, Presbyterian Hospital, PA, USA
e Head and Neck Division of Anatomic Pathology, University of Pittsburgh Medical Center, Presbyterian Hospital, PA, USA
f Anatomical Pathology, ACT Pathology, Canberra Health Services, Canberra, ACT, Australia
g School of Medicine and Psychology, College of Science and Medicine, Australian National University, Canberra, ACT, Australia
h Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
i Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
j The Fingerland Department of Pathology, Charles University Faculty of Medicine in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
k Department of Oncopathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
l Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
m Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
n Department of Tissue Pathology and Diagnostic Oncology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, NSW, Australia
o Department of Mathematics and Statistics, University of Sydney, Sydney, NSW, Australia
p Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
q Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
r Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
s Department of Pathology and Otolaryngology Head and Neck Surgery, Washington University School of Medicine, Saint Louis, MO, USA
t Department of Anatomic and Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
u Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
v Oncology and Haematology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
w Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
x Department of Pathology, Institut de Pathologie Multisite, CHU Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
y Department of Anatomical Pathology, Pathology Queensland, Princess Alexandra Hospital, Woolloongabba, Qld Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
z Department of Oral and Maxillofacial Pathology, Federal University of Minas Gerais, Faculty of Medical Science of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
aa Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
ab Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
ac Department of Pathology, Sarawak General Hospital, Kuching, Sarawak, Malaysia
ad Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
ae Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
af Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya
ag Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
ah Department of Laboratory Medicine, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, India
ai Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
*Correspondence to: Professor Sun Och Yoon, Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, South KoreaDepartment of PathologySeverance HospitalYonsei University College of MedicineSeoul03722South Korea
Summary |
Histopathologically detected extranodal extension leads to upstaging and treatment escalation in head and neck squamous cell carcinoma. There is considerable variation in the prevalence of histopathologically detected extranodal extension in comparable studies. The Head and Neck Cancer International Group, which includes 23 organisations managing patients with head and neck cancer, identified several challenges in evaluating histopathologically detected extranodal extension. Thus, the Head and Neck Consensus Language for Ease and Reproducibility (HN-CLEAR) and its global stakeholders prioritised developing diagnostic criteria and uniform terminology for histopathologically detected extranodal extension. The histopathologically detected extranodal extension working group established by WHO, International Collaboration on Cancer Reporting, American Joint Committee on Cancer, Union for International Cancer Control, North American Society of Head and Neck Pathology, and American Academy of Oral and Maxillofacial Pathology committees undertook consensus deliberations using scanned whole slides and a PRISMA literature review-based scoping questionnaire. The guidelines were tested by 30 additional pathologists across six continents and strengthened with prescriptive diagnostic criteria and unifying terminology based on the inter-rater concordance analyses. This Review generates practically useful consensus diagnostic recommendations and aligned terminology for addressing the gaps in the histopathologically detected extranodal extension literature. The recommendations can be used globally and cater to all levels of medical resources, practices, and experiences, thus ensuring equitable patient care.
Le texte complet de cet article est disponible en PDF.Plan
© 2026
Elsevier Ltd. Tous droits réservés.
Vol 27 - N° 1
P. e33-e44 - janvier 2026 Retour au numéro
Article précédent
- A comprehensive framework for glioma surgery by the PIONEER Consortium and RANO resect group, part 2: perioperative recommendations for neurological, language, functional, and quality-of-life assessment
- Jasper K W Gerritsen, Philipp Karschnia, Lorenzo Bello, Shawn Hervey-Jumper, Jacob S Young, Kathleen Seidel, Djaina D Satoer, Oliver Schnell, Michael Parsons, Brian V Nahed, Grazia Menna, Nico Teske, External Rater Panel, Timothy R Smith, Nader Sanai, Sandro M Krieg, Philippe Schucht, Marike L D Broekman, Steven De Vleeschouwer, Asgeir S Jakola, Martin J van den Bent, Susan M Chang, Michael A Vogelbaum, Arnaud J P E Vincent, Joerg-Christian Tonn, Mitchel S Berger, Keyoumars Ashkan, Marion Barberis, Chetan Bettegowda, Florien Boele, Richard W. Byrne, Daniel P. Cahill, Daniel Delev, Elke De Witte, Katharine Drummond, Johnny Duerinck, Gavin Dunn, Samuel Emerson, Yoshua Esquenazi, Christian F. Freyschlag, Marjolein Geurts, Rachel Grossman, Constantinos G. Hadjipanayis, Margret Jensdottir, Markus Klimek, Chanhung Lee, Amy Maguire, Alireza Mansouri, James M. Markert, Yoshitaka Narita, Alessandro Olivi, Johan Pallud, Karin Piil, Matthias Preusser, Alfredo Quinones-Hinojosa, Jane Skjøth-Rasmussen, Michael Sabel, Christian Senft, Susan Short, Ole S. Solheim, Walter Stummer, Andrea Szelényi, Einar O. Vik-Mo, Colin Watts, Michael Weller, Patrick Wen
- Development of a core outcome set for adolescents and young adults with cancer
- Anne-Sophie Darlington, Kirsty Way, Nicole Collaço, Charlotte Cairns, Simone Hanebaum, Silvie H M Janssen, Urška Košir, Martin G McCabe, Daniel Stark, Samantha C Sodergren, Winette T A van der Graaf, Olga Husson, STRONG AYA Consortium
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?