Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma.

Approach: Patients with a histological diagnosis of ENE (pENE  +  ) were considered “cases” and patients with negative histological examination for ENE (pENE  −  ) were considered “controls.” Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT  >  15  mm) and a minor nodes (MiN) group (lymph nodes on CT  ≤  15  mm). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans.

Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE  +   patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE  −   patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results.

Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.