title: PET/CT imaging and human papilloma virus-positive oropharyngeal squamous cell cancer: evolving clinical imaging paradigm.
abstract: Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) represents an emerging disease that differs from HPV-negative OPSCC in natural history and prognosis. Contrast-enhanced PET/CT is essential to accurately stage the primary site when there are smaller tumors; neck nodal metastases, which tend to have a more cystic component; and distant metastases that manifest in unusual sites (disseminating phenotype) such as bones and other solid organs, including brain. Metastases tend to appear later in the disease course during follow-up for HPV-positive OPSCC than for HPV-negative OPSCC. Because HPV-positive OPSCC patients have a better clinical outcome, there is a need for treatment deintensification to spare the patient from treatment-related toxicities. (18)F-FDG PET/CT would play a role in monitoring patients with deintensified treatments to ensure that no adverse outcome is introduced. The better prognosis and outcome of HPV-positive OPSCC patients would warrant imaging follow-up that is less intense but continues longer because of the manifestation of distant metastases later in the disease course and at unusual sites. All these clinical paradigms facilitate a definite role for PET/CT imaging in the management of HPV-positive OPSCC.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Rathan M
authors.initials: RM
authors.lastname: Subramaniam
authors.forename: Krishna C
authors.initials: KC
authors.lastname: Alluri
authors.forename: Abdel K
authors.initials: AK
authors.lastname: Tahari
authors.forename: Nafi
authors.initials: N
authors.lastname: Aygun
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
mesh_terms: D006801:Humans; D064847:Multimodal Imaging / Q000379:methods*; D018307:Neoplasms, Squamous Cell / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy / Q000821:virology; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy / Q000821:virology; D027383:Papillomaviridae / Q000502:physiology*; D049268:Positron-Emission Tomography / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: HPV; OPSCC; PET/CT; general oncology