Extranodal extension (ENE) of metastatic squamous cell carcinoma in a cervical lymph node changes the nodal stage to at minimum:

• A N2a regardless of node size
• B N2b if multiple nodes are involved
• C N3a if a node >6 cm is present
• D N3b regardless of node size or laterality ✓

Explanation

In AJCC 8th edition for HPV-negative head and neck SCC, any pathological extranodal extension automatically upstages to N3b, irrespective of the number, size, or laterality of nodes. This reflects the significantly worse prognosis conferred by ENE, which indicates adjuvant chemoradiotherapy rather than radiotherapy alone. N3a is reserved for nodes >6 cm without ENE.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.