Differences in imaging characteristics of HPV-positive and HPV-Negative oropharyngeal cancers: a blinded matched-pair analysis

• Published in: American journal of neuroradiology : AJNR Vol. 34; no. 10; pp. 2005 - 2009
• Main Authors: Cantrell, S C, Peck, B W, Li, G, Wei, Q, Sturgis, E M, Ginsberg, L E
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01-10-2013
• Subjects: Adult; Aged; Alcohol Drinking - epidemiology; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - secondary; Female; Head & Neck; Human papillomavirus 16 - isolation & purification; Humans; Incidence; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Oropharyngeal Neoplasms - diagnostic imaging; Oropharyngeal Neoplasms - epidemiology; Oropharyngeal Neoplasms - pathology; Papillomavirus Infections - epidemiology; Papillomavirus Infections - pathology; Prognosis; Retrospective Studies; Risk Factors; Single-Blind Method; Smoking - epidemiology; Tomography, X-Ray Computed
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a3524

Human papillomavirus-positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.
A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ(2) test was used for the matched-pair analysis.
By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).
In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.