Prognostic Value of Radiologic Extranodal Extension in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma

Abstract

Objective To determine whether radiologic extranodal extension (ENE) appearing on pretreatment CT and MRI could predict the prognosis in patients with human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC). Materials and Methods The study population was obtained from a historical cohort diagnosed with HPV-related OPSCC. A total of 134 OPSCC patients who had a metastatic lymph node on pretreatment CT or MRI were included, and radiologic ENE was evaluated by two experienced head and neck radiologists. Kaplan-Meier and multivariate Cox regression analyses were performed to evaluate the impact of radiologic ENE on progression-free survival (PFS). The diagnostic performance of CT and MRI for the diagnosis of ENE was also evaluated in patients who underwent neck dissection. Results Seventy patients (52.2%) showed radiologic ENE-positive findings. Although patients showing radiologic ENE had a worse 3-year PFS (83.7% vs. 95.3%, p = 0.023), the association between radiologic ENE and PFS was not statistically significant on multivariate analysis ( p = 0.141; hazard ratio, 2.68; 95% confidence interval, 0.72–9.97). CT or MRI had a sensitivity of 62%, specificity of 77.8%, and accuracy of 71.9% for predicting pathologic ENE. Conclusion Radiologic ENE on CT or MRI did not predict poor PFS in patients with HPV-related OPSCC, although there was a trend towards worse PFS. Further studies are warranted to determine whether radiologic ENE is a useful imaging biomarker to risk-stratify patients with HPV-related OPSCC.

Oropharyngeal squamous cell carcinoma: radiomic machine-learning classifiers from multiparametric MR images for determination of HPV infection status

“…P16 immunohistochemistry or HPV DNA detection by polymerase chain reaction (PCR) was used as the reference standard 35,36 . P16 immunohistochemistry was performed using CINtec p16 histology (anti-p16 INK4a mouse monoclonal antibody and immunohistochemical detection kit; Roche MTM Laboratories, Heidelberg, Germany) and HPV DNA detection was performed by 16,18,31,33,35,39,45,51,52,56,58,59,68,73,82, and other lower or undetermined risk subtypes) 37 . HPV-positive OPSCC was diagnosed based on the positive results of either p16 or HPV DNA PCR 38 .…”

Utilizing Artificial Intelligence for Head and Neck Cancer Outcomes Prediction From Imaging

“…Pretreatment imaging has a low sensitivity for detection of ENE, with reported sensitivities of 50% to 60%. 59,60 Extranodal extension is a poor prognostic factor in HNSCC. 61,62 In HPV-associated oropharyngeal cancer, it is considered a relative contraindication for TOS since patients with ENE will require adjuvant chemoradiation.…”

PET/CT Poorly Predicts AJCC 8th Edition Pathologic Staging in HPV‐Related Oropharyngeal Cancer

“…Sensitivity and specificity of predicting ECE on CT in patients with HPV+ OPSCC range from 43.7% to 65% and from 54% to 97.7% respectively, whereas those of MRI range from 57% to 77% and from 57% to 72%, respectively. [19][20][21] Radiologic examination of ECE in preoperative PET/CTs of our patient population demonstrated poor accuracy in comparison to pathologic examination and poor interrater reliability between radiologists (κ = 0.403). These results indicate that PET/CT is not a reliable indicator of ECE in patients with HPV+ OPSCC.…”

“…Several studies have shown that ECE may not be a significant prognosticator of HPV+ OPSCC. 23,24 The decision to employ surgical versus nonsurgical treatment critically relies on the severity of nodal disease, T classification, and ECE. With adequate surgical exposure and anatomical favorability for a complete resection, surgical approach can spare the patients a potentially avoidable adjuvant therapy.…”