i read a CT can show ECS, sometimes, and forget the details, and there are always details lol. As Ed explained, ECS is different than ECE, and one is microscopic and other macroscopic, and is surely confusing. I think if its absent in any report is none was seen, but as T mentioned, it wasn't until they went to remove them it was apparent. They can also tell by the size of the node it may. Don, most HPVOPC are poorly differentiated.