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<!DOCTYPE html>
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<meta name="DC.Title" content="Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3524" />
<meta name="DC.Date" content="2013-05-16" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2013 American Society of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Human papillomavirus–positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.

MATERIALS AND METHODS: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ2 test was used for the matched-pair analysis.

RESULTS: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).

CONCLUSIONS: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.

### Abbreviations

HPV
:   human papillomavirus
SCCOP
:   squamous cell carcinomas of the oropharynx
EGFR
:   epidermal growth factor" />
<meta name="DC.Contributor" content="S.C. Cantrell" />
<meta name="DC.Contributor" content="B.W. Peck" />
<meta name="DC.Contributor" content="G. Li" />
<meta name="DC.Contributor" content="Q. Wei" />
<meta name="DC.Contributor" content="E.M. Sturgis" />
<meta name="DC.Contributor" content="L.E. Ginsberg" />
<meta name="article:published_time" content="2013-05-09" />
<meta name="article:section" content="HEAD &amp;amp; NECK" />
<meta name="citation_title" content="Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Human papillomavirus–positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ&lt;sup&gt;2&lt;/sup&gt; test was used for the matched-pair analysis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, &lt;i&gt;P&lt;/i&gt; = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, &lt;i&gt;P&lt;/i&gt; = .002).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2013/05/09" />
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<meta name="citation_author" content="S.C. Cantrell" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="B.W. Peck" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="G. Li" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="Q. Wei" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="E.M. Sturgis" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
<meta name="citation_author" content="L.E. Ginsberg" />
<meta name="citation_author_institution" content="From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota." />
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<meta name="twitter:title" content="Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Human papillomavirus–positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.

MATERIALS AND METHODS: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ2 test was used for the matched-pair analysis.

RESULTS: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).

CONCLUSIONS: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.

### Abbreviations

HPV
:   human papillomavirus
SCCOP
:   squamous cell carcinomas of the oropharynx
EGFR
:   epidermal growth factor" />
<meta name="og-title" property="og:title" content="Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2013/05/16/ajnr.A3524" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Human papillomavirus–positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.

MATERIALS AND METHODS: A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ2 test was used for the matched-pair analysis.

RESULTS: By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).

CONCLUSIONS: In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.

### Abbreviations

HPV
:   human papillomavirus
SCCOP
:   squamous cell carcinomas of the oropharynx
EGFR
:   epidermal growth factor" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">HEAD &amp; NECK</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.C. Cantrell</span>, <span class="highwire-citation-author" data-delta="1">B.W. Peck</span>, <span class="highwire-citation-author" data-delta="2">G. Li</span>, <span class="highwire-citation-author" data-delta="3">Q. Wei</span>, <span class="highwire-citation-author" data-delta="4">E.M. Sturgis</span> and <span class="highwire-citation-author" data-delta="5">L.E. Ginsberg</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2013,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3524 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-50237--61537379428" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.C. Cantrell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.C.%2BCantrell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cantrell%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.C.%2BCantrell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B.W. Peck </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.W.%2BPeck%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Peck%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AB.W.%2BPeck%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">G. Li </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BLi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Li%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BLi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Q. Wei </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Q.%2BWei%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wei%20Q&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AQ.%2BWei%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">E.M. Sturgis </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.M.%2BSturgis%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sturgis%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AE.M.%2BSturgis%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">L.E. Ginsberg </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Departments of Diagnostic Imaging (S.C.C., L.E.G.), Epidemiology (G.L., Q.W., E.M.S.), and Head and Neck Surgery (G.L., E.M.S.), University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiology (S.C.C.), University of Texas Health Science Center, Houston, Texas; and Department of Otorhinolaryngology (B.W.P.), Mayo Clinic, Rochester, Minnesota.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.E.%2BGinsberg%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ginsberg%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AL.E.%2BGinsberg%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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      <div class="highwire-cite-title">Differences in Imaging Characteristics of HPV-Positive and HPV-Negative Oropharyngeal Cancers: A Blinded Matched-Pair Analysis</div>  
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