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Intranodal Cystic Changes: A Potential Radiologic Signature/Biomarker to Assess the Human Papillomavirus Status of Cases With Oropharyngeal Malignancies

Morani, Ajaykumar C. MBBS, DNB, MD; Eisbruch, Avraham MD; Carey, Thomas E. MD; Hauff, Samantha J. MD; Walline, Heather M. MD; Mukherji, Suresh K. MD

Journal of Computer Assisted Tomography: May/June 2013 - Volume 37 - Issue 3 - p 343–345
doi: 10.1097/RCT.0b013e318282d7c3

Objective The aim of this study was to determine if lymph node imaging findings can predict human papillomavirus (HPV) positivity in oropharyngeal squamous cell cancers.

Methods and Materials Pretreatment postcontrast neck computed tomographic scans of 49 patients (male, 35; female, 14; age range, 45–76 years) diagnosed with oropharyngeal malignancies and with available HPV data were retrospectively reviewed. Metastatic lymph nodes were identified based on standardly accepted size and morphological criteria. Various lymph node parameters were studied, including presence of cystic foci in the metastatic lymph nodes, abnormal lymph nodes showing low-attenuation foci, matted lymph nodes, and morphologically normal smaller (<1.5 cm) lymph nodes. These parameters were then independently correlated with the available HPV status of these patients. Finally, an extended criterion, that is, intranodal cystic changes in cases with morphologically normal small (<1.5 cm) lymph nodes, was correlated with HPV status. Sensitivity, specificity, and positive predictive values (PPVs) and negative predictive values (NPVs) were calculated.

Results Of these 49 cases with oropharyngeal cancers, 27 were HPV positive, and 22 cases were HPV negative. Eight cases (3 HPV positive and 5 HPV negative) did not have metastatic lymph nodes. Of remaining 41 cases with metastatic abnormal lymph nodes, 26 were HPV positive, and 15 were HPV negative. Of these 41 cases with metastatic lymph nodes, 14 had 1 or more lymph nodes with cystic foci. Of these 14 cases, 10 (71.4%) were HPV positive. Resultant sensitivity, specificity, PPV, and NPV of cystic foci for the presence of HPV status were 38.4%, 73.3%, 71.4%, and 40.7%, respectively. Intranodal cystic changes in cases with morphologically normal small (<1.5 cm) lymph nodes were found in 5 cases; all 5 were HPV positive. Resultant accuracy was specificity and PPV of 100%, sensitivity of 19.2% and NPV of 41.6%.

Conclusions Intranodal cystic changes seen on the pretreatment postcontrast neck computed tomographic scan of patients with oropharyngeal malignancies are radiologic signatures strongly associated with the HPV status of the patient. The results in this initial study warrant larger prospective studies to determine if this finding may be used in addition to other molecular biomarkers to help identify those patients who may be amenable to the most appropriate treatment options.

From the *Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX; †Otolaryngology and Radiation Oncology, and ‡Department of Radiology, University of Michigan, Ann Arbor, MI.

Received for publication October 21, 2012; accepted December 12, 2012.

Reprints: Ajaykumar C. Morani, MBBS, DNB, MD, Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 (e-mail:

This research is supported in part by the National Institutes of Health through the University of Michigan’s Head and Neck SPORE Grant (P50 CADE97248), NIH NCI through the University of Michigan’s Cancer Center Core Grant (P30 CA46592), and NIH NIDCR R01 DE019126.

The authors report no conflicts of interest.

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