title: Retropharyngeal lymph node involvement in human papillomavirus-associated oropharyngeal squamous cell carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively review patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) for the presence of retropharyngeal lymph nodes (RPLNs) prior to treatment using positron emission tomography/computed tomography (PET/CT), and to determine if the presence of RPLNs is of utility in predicting outcomes.
  
  
  METHODS
  Retrospective review of patient data from a single institution.
  
  
  METHODS
  Two hundred thirty patients with a diagnosis of HPV-associated OPSCC were identified from 2002 to 2013. The presence of RPLNs was determined primarily from findings on PET/CT as reviewed in a standardized fashion by two neuroradiologists.
  
  
  RESULTS
  Of the 230 patients, 165 had pretreatment PET/CT imaging available for review. There were a total of 16 patients (9.70%) with evidence of RPLNs. Among patients positive for RPLNs pretreatment, with an average follow-up of 2 years, there was a 5.2-times greater odds of having recurrence or death (31.3% vs. 8.1%, P=.004). When T and N stage were adjusted for with multiple regression, there was no significant association between RPLN status and recurrence free survival.
  
  
  CONCLUSIONS
  This is a unique investigation utilizing PET/CT to classify RPLN status in HPV-associated OPSCC. RPLNs were relatively common in our HPV-associated OPSCC cohort at 9.70%, at the low end of the quoted positivity of 10% to 27% in all OPSCC. A combination of PET/CT is useful in identifying RPLNs. Prospective investigation will be needed to determine the sensitivity and specificity of PET/CT in identifying RPLNs, and the precise impact of RPLNs on HPV-associated OPSCC treatment and outcomes.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology, Naval Medical Center San Diego, San Diego, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Baxter
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Jason Y K
authors.initials: JY
authors.lastname: Chan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Wojciech K
authors.initials: WK
authors.lastname: Mydlarz
authors.affiliation: Department of Radiology-Neuroradiology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Salvatore V
authors.initials: SV
authors.lastname: Labruzzo
authors.affiliation: Department of Radiation Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.
authors.forename: Ana
authors.initials: A
authors.lastname: Kiess
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Ha
authors.affiliation: Department of Radiology-Neuroradiology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Nafi
authors.initials: N
authors.lastname: Aygun
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Nishant
authors.initials: N
authors.lastname: Agrawal
mesh_terms: D000368:Aged; D052685:Alphapapillomavirus; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000821:virology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000821:virology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology* / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications*; D011859:Radiography; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D014062:Tongue Neoplasms / Q000473:pathology / Q000821:virology; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000821:virology
keywords: Human papillomavirus-associated oropharyngeal squamous cell carcinoma; head and neck cancer; human papillomavirus; retropharyngeal lymph nodes