McMullen CP, Garneau J, Weimar E, 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, the investigators evaluated the rate of nodal upstaging and occult extranodal extension (ENE). Data reported that 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 continues a challenge to predict preoperative pathological staging for OPSCC patients undergoing transoral robotic surgery and neck dissection. While nodal size, tumor size and location do not help predict ENE, the presence of nodes in the category of image and nodal may help predict ENE. The results obtained from the study 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.