Department of Medical Imaging, Gold Coast University Hospital, Southport, Queensland, Australia.
School of Medicine, Griffith University, Southport, Queensland, Australia.
J Med Imaging Radiat Oncol. 2021 Apr;65(2):175-181. doi: 10.1111/1754-9485.13140. Epub 2021 Feb 16.
This is first Australian population-based retrospective study in HPV-induced OPSCCs utilising CT. Contrast enhanced computed tomography (CECT) was utilised to assess if imaging findings of metastatic cystic lymph nodes (LNs) can predict human papillomavirus (HPV) status, as defined by p16 immunostaining of oropharyngeal squamous cell carcinomas (OPSCCs).
The location and p16 status of primary tumours and LNs were recorded. Metastatic LNs were assessed for size, shape, margins and cystic changes. Hounsfield Units (HU) value of primary tumours and LNs were measured and tabulated. p16-positive and p16-negative groups were compared with respect to these variables. The two-sample t test and two-sample Mann-Whitney test was used.
A total of 364 CECT scans were reviewed with 209 patients (187 p16 positive and 22 p16 negative). Primary sites of OPSCCs were tonsils (58.8%), base of tongue (37.4%) and other oropharyngeal sites (3.8%). The HU values of p16-positive OPSCCs with mean of 78.6HU; 95% CI (76.5-80.8) were lower for p16-negative tumours, mean 96.0 HU CI 95% (85.5-106.6) for all oropharyngeal sub-sites. The mean HU values of p16-positive and p16-negative metastatic LNs were 38.8 HU 95% CI: (13-103 HU) versus 88.7 HU 95% CI: (54-131) (P < 0.0001).
The association between p16-positive status and the tonsillar cancer site is very high. Imaging features of p16-positive metastatic LNs include relatively large cystic neck nodes with low HU values. This is an imaging signature of p16-positive OPSCCs and can potentially influence patient's early diagnosis and prognosis.
这是澳大利亚首次利用 CT 对 HPV 诱导的口咽鳞状细胞癌（OPSCC）进行的基于人群的回顾性研究。利用对比增强计算机断层扫描（CECT）评估转移性囊性淋巴结（LNs）的影像学表现是否可以预测人乳头瘤病毒（HPV）状态，其定义为口咽鳞状细胞癌（OPSCC）的 p16 免疫染色。
记录原发肿瘤和 LNs 的位置和 p16 状态。评估转移性 LNs 的大小、形状、边界和囊性改变。测量和列出原发肿瘤和 LNs 的亨氏单位（HU）值。比较 p16 阳性和 p16 阴性组的这些变量。使用双样本 t 检验和双样本曼-惠特尼检验。
共回顾了 364 次 CECT 扫描，涉及 209 例患者（187 例 p16 阳性，22 例 p16 阴性）。OPSCC 的原发部位为扁桃体（58.8%）、舌根（37.4%）和其他口咽部位（3.8%）。p16 阳性 OPSCC 的 HU 值平均值为 78.6HU；95%CI（76.5-80.8）低于所有口咽亚部位 p16 阴性肿瘤的 96.0 HU CI 95%（85.5-106.6）。p16 阳性和 p16 阴性转移性 LNs 的平均 HU 值分别为 38.8 HU 95%CI：（13-103 HU）和 88.7 HU 95%CI：（54-131）（P < 0.0001）。
p16 阳性状态与扁桃体癌部位的相关性非常高。p16 阳性转移性 LNs 的影像学特征包括相对较大的囊性颈部淋巴结，HU 值较低。这是 p16 阳性 OPSCC 的影像学特征，可能会影响患者的早期诊断和预后。
