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SM Journal of Radiology

Impact of Criteria, Training, and Diagnostic Certainty on Community Radiologists’ Assessment of Imaging-Detected Extranodal Extension in HPV Positive Oropharyngeal Carcinoma

[ ISSN : 3067-9702 ]

Abstract
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Received: 16-Sep-2025

Accepted: 08-Nov-2025

Published: 10-Nov-2025

Research Article | Volume 7 - Issue 1 | Article DOI :

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Shao Hui Huang, Eugene Yu,Jie Su, Kristoff Nelson, Marie Duguet Armand,Youri Kaitoukov,Brij Kapadia,Nayela Keen, Anne C Kim,Cerny Milena, Sapna J Palrecha, Anne Preville-Gendreau, Kirk Simon,Suhad Tantawi,Joongchul Paul Yoon,Horia Vulpe, Wei Xu,Houda Bahig, William Lydiatt,Barton F. Branstetter IV,Ezra Hahn, Brian O’Sullivan

1Department of Radiation Oncology, Princess Margaret Cancer Center/University of Toronto, Canada

2Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center/University of Toronto, Canada

3Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Canad

4Department of Biostatistics, Princess Margaret Cancer Center/University of Toronto, Canada

5Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM)/Université de Montréal, Canada

6Department of Radiology, Hôpital de Saint-Eustache, Centre intégré de santé et de services sociaux des Laurentides, Canada

7Department of Radiology, Jewish General Hospital, Canada

8Department of Radiology, the Permanente Medical Group, USA

9Department of Radiology, the Regional Hospital du Grand Portage, Canada

10Department of Radiation Oncology, the Permanente Medical Group, USA

11Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM)/Université de Montréal, Canada

12Department of Surgery, Creighton University, USA

13Department of Radiology, University of Pittsburgh, USA

 

Corresponding Author:

Brian O’Sullivan, Department of Radiation Oncology, University of Toronto, RM 7-323, Department of Radiation Oncology, the Princess Margaret Hospital, 700 University Ave. Toronto, ON, Canada, M5G 1Z5, Tel: (416) 946-2983; Fax: (416) 946-4586

Keywords

HPV-Positive Oropharyngeal Carcinoma; Extranodal Extension; Computed Tomography, Magnetic Resonance Imaging, Inter-Rater Concordance

Abstract

Purpose/Objective(s): The UICC and AJCC have recently added imaging-detected extranodal extension (iENE) as a cN modifier for the upcoming 9th edition TNM Classification (TNM9) of HPV-positive oropharyngeal carcinoma (HPV+ OPC). While academic radiologists demonstrate good inter-rater reliability in identifying imaging-detected extranodal extension (iENE), its reliability among community radiologists has not been studied. Therefore, we conducted an international study to assess the reliability and impact of training on iENE recognition by two groups of community radiologists in the USA and Canada. Materials/Methods: Community radiologists from The Permanente Medical Group (TPMG) and a Quebec Radiology Group (QR) who responded to “Expression-of-Interest” emails were recruited. They were asked to consult training material addressing the Head-and-Neck Cancer-International Group consensus definitions of iENE status before proceeding with a Round-1 (20 cases) and Round-2 (30 cases) iENE review. After each round, expert interpretations were provided to both groups for self-reflection. The TPMG group also had an online group review following Round-1. Gwet’s AC1 concordance score was estimated for the overall, TPMG, and QR groups. Results: A total of 10 radiologists (5 each from TPMG and QR groups) were recruited. The mean (standard deviation) agreement for Round-1 and Round-2 was 86.0% (7.4) and 86.0% (6.0), respectively. The Gwet’s AC1 concordance score were 0.72 (0.50-0.93) (moderate) and 0.76 (0.62-0.89) (substantial) in Round-1 and Round-2, respectively. Gwet’s AC1 score in Round-1 vs Round-2 was 0.74 (0.53-0.95) (moderate) vs 0.82 (0.69-0.94) (substantial) for the TPMG group, and 0.72 (0.48-0.97) (moderate) vs 0.69 (0.50-0.88)] (moderate) for the QR group, respectively. Conclusion: This study shows good inter-rater reliability for iENE status among community radiologists after applying the Head and-Neck-Cancer-International Group consensus definitions, and using high diagnostic certainty. With adherence to guidelines, wider dissemination of HPV+ OPC prognostic models that include iENE status appear feasible. Educational materials are also available to further augment reproducibility. Keywords: HPV-Positive Oropharyngeal Carcinoma; Extranodal Extension; Computed Tomography, Magnetic Resonance Imaging, Inter-Rater Concordance

Citation

O’Sullivan B, Huang SH, Yu E, Su J, Nelson K et al, (2025) Impact of Criteria, Training, and Diagnostic Certainty on Community Radiologists’ Assess ment of Imaging-Detected Extranodal Extension in HPV-Positive Oropharyngeal Carcinoma. SM J Radiol 8(1): 8.