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FDG PET/CT Imaging of Oropharyngeal Squamous Cell Carcinoma: Characteristics of Human Papillomavirus–Positive and –Negative Tumors

Tahari, Abdel K. MD, PhD*; Alluri, Krishna C. MBBS*; Quon, Harry MD; Koch, Wayne MD; Wahl, Richard L. MD*; Subramaniam, Rathan M. MD, PhD, MPH*†

doi: 10.1097/RLU.0000000000000255
Original Articles

Objective: The objective of this study was to assess differences in morphological and glycolytic characteristics of primary tumors and locoregional nodal disease between human papillomavirus (HPV)–positive and HPV-negative oropharyngeal head and neck squamous cell carcinoma.

Methods: This was a retrospective analysis of 123 baseline FDG PET/CT scans from patients (aged 57.0 ± 10.6 years) with newly diagnosed oropharyngeal SCC between January 2003 and June 2012. There were 98 HPV-positive and 25 HPV-negative patients. SUVmax, SUVpeak, and SUVmean based on lean body mass, as well as RECIST (Response Evaluation Criteria In Solid Tumors) dimensions, metabolic tumor volume (gradient and threshold-segmentation methods) and total lesion glycolysis, were determined for primary and locoregional nodal disease.

Results: Human papillomavirus–negative primary tumors were significantly larger as measured by RECIST longest diameter (P = 0.002) and slightly more heterogeneous as measured by the heterogeneity index (P = 0.07), higher SUVmax (P < 0.01), SUVpeak (P = 0.01), SUVmean (P = 0.01), metabolic tumor volume (P = 0.002), and total lesion glycolysis (P = 0.001), for both segmentation methods. Index parameters of HPV-positive nodal disease tend to be larger, but some with no statistical significance (P > 0.05). There was no significant difference in the metabolic parameters of primary tumor or nodal metastases for HPV-positive patients with and without smoking history.

Conclusions: Index morphologic and glycolytic parameters as measured in FDG PET/CT are significantly larger in HPV-negative as compared with HPV-positive primary oropharyngeal carcinoma. In contrast, the same parameters trended to be larger in HPV-positive regional nodal disease.

From the *Russell H. Morgan Department of Radiology and Radiological Sciences and Departments of †Radiation Oncology; and ‡Otolaryngology and Head and Neck Surgery, Johns Hopkins University, Baltimore, MD.

Received for publication July 17, 2013; and revision accepted August 27, 2013.

Conflicts of interest and sources of funding: A.K.T. was supported by the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health under award number T32EB006351.

Reprints: Rathan M. Subramaniam, MD, PhD, MPH, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, 601 N Caroline St/JHOC 3235, Baltimore, MD 21287. E-mail:

© 2014 by Lippincott Williams & Wilkins