Arrows point to nodes of interest. (a) True +: Level 1 b node positive for HNSCC and ECS; observers identify infiltration into adjacent tissues, indistinct nodal margins, and central node necrosis. (b) True −: Level 1 b node positive for HNSCC but no ECS; observers do not identify any ECS criteria. (c) False −: Level 2 positive for 1 cm HNSCC focus and ECS; observers do not identify any ECS criteria. (d) False +: Level 2 node positive for HNSCC but no ECS; observers identify irregular nodal enhancement, infiltration into adjacent tissues, indistinct nodal margins, matted nodes and central necrosis. HNSCC: squamous cell carcinoma of the head and neck; ECS: extracapsular spread.