Hu Y, et al. - In stage II nasopharyngeal carcinoma (NPC), researchers examined the prognostic ability of radiologic extra-nodal extension (rENE). They recruited and divided stage II NPC patients with N1 category (n=365) into 3 groups according to the situation of rENE: without rENE, suspected rENE, and confirmed rENE (grades: A, infiltration into surrounding fat; B, matted nodes; C, infiltration into adjacent structures). According to findings, high-grade rENE (a stable criterion, with high intra-rater and inter-rater consistency) was an evaluable predictor that could assist select stage II patients with a high risk of distant metastasis. Only high-grade rENE (including matted nodes and infiltration into adjacent structures) could significantly impact survival outcomes; patients with high-grade rENE had significantly poorer survival than those without.