McMullen CP, et al. - In a multi-institutional population of patients with pathologic (p)T1-2 oropharyngeal squamous cell carcinoma (OPSCC) treated by transoral robotic surgery and neck dissection, researchers evaluated the rate of nodal upstaging and occult extranodal extension (ENE). The rate of occult extranodal extension on final pathologic findings was 13% in this retrospective, cohort study of 92 patients with OPSCC from three different centers. Findings revealed that it remains a challenge to forecast preoperative pathologic staging for OPSCC patients undergoing transoral robotic surgery and neck dissection. Results indicate that a tiny percentage of patients may benefit from additional adjuvant therapies that are not anticipated through preoperative imaging based on occult nodal upstaging and ENE.