Correlation between imaging-detected and pathological extranodal extension in a randomised trial in Human Papillomavirus-positive oropharyngeal cancer

Evans, Mererid, Hurt, Chris, Rhys, Rhian, Mahajan, Abhishek, McQueen, Andrew, Dixon, Joanna, Robinson, Max, Robinson, Neil, Hunter, Keith, Christian, Adam, Jones, Adam, Queiroz, Aline, Huang, Shao Hui, O’Sullivan, Brian, Canham, Joanna ORCID: https://orcid.org/0000-0003-3482-0990, Heiberg, Christie and Jones, Terry 2025. Correlation between imaging-detected and pathological extranodal extension in a randomised trial in Human Papillomavirus-positive oropharyngeal cancer. British Journal of Cancer 10.1038/s41416-025-03291-z

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Abstract

Background Imaging-detected and pathological extranodal extension (iENE, pENE) negatively impact prognosis in Human Papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC), as reflected in future TNM staging updates. Correlation between iENE and pENE in HPV-positive OPSCC is currently unknown yet is vital to determine how iENE should be used to influence treatment decisions. Methods PATHOS is a trial of de-intensified adjuvant treatment after transoral surgery for HPV-positive OPSCC. 291 consecutively recruited patients undergoing surgery at three UK centres were included. Pre-operative cross-sectional imaging (CT and/or MRI) was independently scored for iENE by 2 expert radiologists; pENE was scored by 2 expert pathologists. Results Inter-rater agreement for iENE was fair in round 1 (Gwet’s AC: 0.34 (95%CI:0.26–0.41)) but improved to very good after second review (Gwet’s AC: 0.88 (95%CI:0.85–0.93), Agreement: 0.91 (95%CI:0.87–0.94)). Sensitivity of iENE for predicting pENE was relatively low (at best: 56.4% (95%CI:42.3–69.7) and specificity was high (at worst: 70.9% (95%CI:65.0–76.3)). Excluding cases with suboptimal image quality and recent core biopsy produced modest improvements in sensitivity (up to 59.4% (95%CI:40.6–76.3)) and specificity (up to 87.8% (95%CI:80.4–93.2)). Discussion The high specificity could help select iENE-negative patients for surgery, but higher sensitivity is required before excluding surgery based solely on iENE positivity.

Item Type:	Article
Date Type:	Publication
Status:	In Press
Schools:	Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR)
Publisher:	Springer Nature
ISSN:	0007-0920
Date of First Compliant Deposit:	9 December 2025
Date of Acceptance:	14 November 2025
Last Modified:	09 Dec 2025 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/183019

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