Radiologic Differences between Human Papillomavirus-Related and Human Papillomavirus-Unrelated Oropharyngeal Carcinoma on Diffusion-Weighted Imaging

Abstract

Background and Purpose: Human papilloma virus-related oropharyngeal carcinoma (HPV+ OPC) is a unique entity compared to HPV-unrelated (HPV-) OPC. Previous studies were inconclusive regarding the differences between HPV+ and HPV- OPCs on diffusion-weighted imaging (DWI). This study sought to determine if there is an association between HPV status and apparent diffusion coefficient (ADC) values as an imaging biomarker in OPCs. Materials and Methods: OPC patients with pretreatment MRI including DWI were retrospectively reviewed and analyzed as a blinded, controlled cohort. HPV status was biopsy-ascertained with p16 staining. ADC values were determined by placing the largest possible circular region of interest in solid portions of primary tumors and/or metastatic lymph nodes. Necrotic and cystic portions were excluded. Results: Twenty-eight HPV+ and 12 HPV- patients were included. Adjusted for age and sex, ADC values were significantly lower in HPV+ OPC primary tumors (p = 0.013) and lymph node metastases (p = 0.013). The area under the curve (AUC) was 0.85 and 0.90, respectively. A model with a linear combination of the 2 variables yielded an AUC of 0.92. Conclusion: ADC values were significantly lower in both the primary tumors and lymph node metastases in HPV+ OPCs compared to HPV- OPCs. These results confirm the results of prior studies.

Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy

“…HPV-negative tumors were correlated with high ADC-values (r = 0.452). This is in line with some previous studies [28,[33][34][35], in which higher ADC histogram parameters in HPV-negative patients were found. This was confirmed by Meyer et al [36], who found a negative correlation of high ADC max and ADC SD with low P53 expression in HPVnegative tumors, which lead to minimal cell cycle arrest, senescence or apoptosis [37].…”

Quantitative diffusion magnetic resonance imaging for prediction of human papillomavirus status in head and neck squamous-cell carcinoma: A systematic review and meta-analysis

“…23,24 Eventually, five studies were included in the meta-analysis. [8][9][10]25,26 Study characteristics and quality assessment Tables 1 and 2 summarize the patients' characteristics, scanner details, imaging protocol, lesion segmentation method, and HPV status index test. All studies were retrospective.…”

“…A noninvasive imaging biomarker such as ADC could play a substantial role in prognostication and treatment planning, with the additional benefits of being able to evaluate the whole tumor volume and having the potential for repeatability compared to tissue sampling. [8][9][10][11][12] There are currently a limited number of studies evaluating the difference in ADC values of HPV-positive versus HPV-negative HNSCC. Therefore, we performed a meta-analysis to compare the average ADC value of primary tumor lesions between the HPV-positive versus HPV-negative forms of HNSCC.…”

Quantitative diffusion magnetic resonance imaging in head and neck tumors

“…The classical description of HPV-positive oropharyngeal cancer histology is non-keratinizing and basaloid differentiated SCC as opposed to keratinizing and poorly differentiated form which is commonly seen with HPVnegative forms (52). This histopathological difference has perhaps lent itself to the difference in ADC characteristics of HPV-positive versus HPV-negative oropharyngeal SCC (53)(54)(55)(56)(57). Recent studies have generally reported a lower mean ADC in primary lesion of HPV-positive oropharyngeal SCC compared to the HPV-negative form ( Table 3).…”