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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