Extranodal extension (ENE) is widely recognized as one of the most relevant prognostic factors in head and neck oncology, with a direct impact on staging, treatment selection, and oncologic outcomes. In recent years, the growing role of imaging-derived extranodal extension (iENE) has progressively transformed pre-treatment evaluation, making radiological assessment a potentially decisive element in the choice between surgical and non-surgical treatment strategies.

Despite its increasing clinical importance, iENE remains characterized by substantial variability in terminology, grading systems, interpretation criteria, and multidisciplinary application. Differences in radiological interpretation and clinical integration continue to influence therapeutic decision-making across institutions and specialties. For these reasons, the European Head and Neck Society (EHNS), the Head and Neck Cancer International Group (HNCIG), the European Society of Head and Neck Radiology (ESHNR), and the Associazione Italiana di Oncologia Cervico-Cefalica – Italian Head and Neck Society (AIOCC-IHNS) have joined forces to develop this international educational initiative within the framework of the EHNS Academy.