ENE refers to extracapsular extension or spread of cancer from a lymph node. The AJCC 8th edition guidelines describe clinical signs of ENE as a matted lymph node mass, involvement of overlying skin or soft tissue, or signs of cranial nerve or nerve plexus invasion. Radiologically, ENE is suggested by an indistinct nodal margin, irregular capsular enhancement, or infiltration into fat or muscle on CT or MRI. The presence or absence of clinical or radiologic ENE is designated ENE(+) or ENE(-) respectively.

1. ENE IN HEAD AND NECK CANCER
AJCC 8TH EDITION GUIDELINES

2. CLINICAL
1. A “matted” mass of nodes
2. Involvement of overlying skin, adjacent soft
tissue
3. Clinical signs of cranial nerve or brachial
plexus, sympathetic chain or phrenic nerve
invasion

3. RADIOLOGICAL
• Cross-sectional imaging (CT o rMR ) generally
has low sensitivity (6 5 -8 0% ) but high
specificity (86-93 %) for the detection of ENE.
• An indistinct nodal margin,
• Irregular nodal capsular enhancement or
• Infiltration into the adjacent fat or muscle,
with the latter finding on CT and MR imaging
as the most specific sign o f ENE.

4. The absence or presence of clinical/ radiologic
ENE is designated
EN E (-) or ENE(+), respectively.