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 ([Formula: see text]) were considered “cases” and patients with negative histological examination for ENE ([Formula: see text]) were considered “controls.” Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on [Formula: see text]) and a minor nodes (MiN) group (lymph nodes on [Formula: see text]). 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 [Formula: see text] patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of [Formula: see text] 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.