title: Differences in imaging characteristics of HPV-positive and HPV-Negative oropharyngeal cancers: a blinded matched-pair analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Departments of Diagnostic Imaging.
authors: S C
authors: SC
authors: Cantrell
authors: B W
authors: BW
authors: Peck
authors: G
authors: G
authors: Li
authors: Q
authors: Q
authors: Wei
authors: E M
authors: EM
authors: Sturgis
authors: L E
authors: LE
authors: Ginsberg
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000556:secondary; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D015994:Incidence; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
references: Cancer. 2001 Dec 15;92(12):3030-6
references: 11753980
references: N Engl J Med. 2007 May 10;356(19):1944-56
references: 17494927
references: Laryngoscope. 2000 Oct;110(10 Pt 1):1637-41
references: 11037817
references: J Clin Oncol. 2008 Feb 1;26(4):612-9
references: 18235120
references: Int J Cancer. 2005 May 1;114(5):806-16
references: 15609302
references: J Clin Oncol. 2008 Jul 1;26(19):3128-37
references: 18474878
references: Head Neck. 2008 Jul;30(7):898-903
references: 18383529
references: Arch Otolaryngol Head Neck Surg. 1994 Dec;120(12):1370-4
references: 7980903
references: Cancer. 1998 Mar 1;82(5):944-56
references: 9486586
references: Head Neck. 2013 Jul;35(7):999-1006
references: 22733709
references: AJNR Am J Neuroradiol. 2009 Oct;30(9):1628-9
references: 19556351
references: J Laryngol Otol. 1994 Dec;108(12):1068-71
references: 7861083
references: J Clin Oncol. 2006 Feb 10;24(5):736-47
references: 16401683
references: J Natl Compr Canc Netw. 2011 Jun 1;9(6):665-73
references: 21636538
references: Carcinogenesis. 2008 Apr;29(4):875-9
references: 18258602
references: Eur Arch Otorhinolaryngol. 2004 May;261(5):270-5
references: 14504863
references: Clin Cancer Res. 2009 Mar 1;15(5):1779-86
references: 19223504
references: J Natl Cancer Inst. 2008 Mar 19;100(6):407-20
references: 18334711
references: Cancer. 2005 May 1;103(9):1843-9
references: 15772957
references: Head Neck. 2011 Jun;33(6):847-55
references: 20737488
references: N Engl J Med. 2010 Jul 1;363(1):24-35
references: 20530316
references: Eur J Cancer. 2007 Jan;43(2):415-32
references: 17079134
references: Lancet Oncol. 2010 Aug;11(8):781-9
references: 20451455
references: Cancer. 2007 Oct 1;110(7):1429-35
references: 17724670
references: Br J Cancer. 1999 Mar;79(9-10):1437-42
references: 10188887