CT/MRI Extranodal Extension Grading in Nasopharyngeal Carcinoma: High Reliability and Prognostic Utility

A four-tier imaging-derived extranodal extension (iENE) grading system for nasopharyngeal carcinoma on CT/MRI had excellent interrater reliability (ICC 0.87) and predicted survival: grade 3 vs 0 OS hazard ratio 3.30 (P<.001).

• Interrater reliability ICC was 0.87 (95% CI 0.85–0.89) and intrarater κ=0.95 for the iENE grading system among three radiologists.
• All iENE grades (1, 2, 3) showed shorter distant metastasis-free survival than grade 0 (hazard ratios 2.33, 2.11, 2.39; all P≤.02).
• There was no evidence of a difference in prognostic performance between the TNM-8 and TNM-9 staging systems.

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