What Is the Best Imaging Modality to Predict Extracapsular Nodal Extension?

  • Majid KhanEmail author
  • Benyamin Deldar
  • Nafi Aygun
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. Postoperative chemoradiation is superior to postoperative radiotherapy alone in patients with histologically proven extracapsular spread. If extracapsular spread can be detected preoperatively, patients may favor primary chemoradiation instead of primary surgery plus postoperative chemoradiation.

There is no consensus about which imaging modality is best for diagnosis of extra-capsular spread and in this chapter we review the literature and describe the strengths and limitation of each imaging modality and give a personal opinion about how this important finding should be viewed and correlated both clinically and histopathologically.


Extracapsular spread (ECS) Head and neck squamous cell cancer (HNSCC) Oro-pharyngeal cancer (OPC) Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound (USG) Positron emission tomography (PET) Time intensity curve (TIC) Dynamic contrast enhancement (DCE) 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeuroradiologyJohns Hopkins HospitalBaltimoreUSA

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