Highlights
- •In head and neck SCC, the presence of calcifications within cervical lymph nodes may help predict HPV/P16 positivity.
- •HPV is an important cause of head and neck SCC and accounts for a large majority of new cases.
- •Known factors of HPV-positive head and neck SCC include an oropharyngeal primary tumor and cystic lymph nodes.
Abstract
Purpose
Human papillomavirus (HPV) is an important cause of head and neck squamous cell carcinoma
(HNSCC) and accounts for a large majority of new cases. The purpose of this study
is to determine whether there is an association between nodal calcification and HPV
positivity in the setting of metastatic HNSCC.
Methods
Consecutive patients with HNSCC who underwent CT were retrospectively identified.
Patients were then divided into two groups: those with HPV-positive HNSCC and those
with HPV-negative HNSCC. Demographic, clinical, and CT data were compared between
the two groups to determine factors associated with HPV-positive HNSCC.
Results
A total of 179 patients with HNSCC were included in the final analyses, 104 (58%)
of whom had HPV-positive tumors. Univariate analyses demonstrated that those with
HPV-positive HNSCC were more likely to have calcified lymph nodes (p = 0.044). Analyses
also confirmed previously known associations with male gender (p = 0.001), primary
oropharyngeal tumors (p < 0.001), and cystic lymph nodes (<0.001). The HPV-positive
HNSCC group was also less likely to have necrotic lymph nodes (p < 0.001).
Conclusion
In addition to known clinical and imaging factors associated with HPV-positive metastatic
HNSCC, such as male gender, oropharyngeal primary location, and cystic lymph nodes,
the presence of calcifications within cervical lymph nodes, although infrequent, provides
an additional useful feature to predict HPV positivity in HNSCC. Additionally, if
calcified lymph nodes are present, then a primary oropharyngeal tumor site should
be considered.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management.Curr. Oncol. 2019; 26: 119-123
- Epidemiology of HPV-associated oropharyngeal cancer.Oral Oncol. 2014; 50: 380-386
- Special issue about head and neck cancers: HPV positive cancers.Int J Mol Sci. 2020; 21: 3388
- Cystic lymph node metastasis in patients with head and neck cancer: an HPV-associated phenomenon.Head Neck. 2008; 30: 898-903
- Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: relationship with human papillomavirus status and failure patterns.PLoS One. 2017; 12e0180779
- Solid lymph nodes as an imaging biomarker for risk stratification in human papillomavirus-related oropharyngeal squamous cell carcinoma.AJNR Am J Neuroradiol. 2017; 38: 1405-1410
- Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach.AJR Am J Roentgenol. 2013; 200: W17-W25
- The spectrum of benign and malignant etiologies of cervical node calcification.AJR Am J Roentgenol. 1999; 172: 1433-1437
- Metastatic squamous cell carcinoma presenting as diffuse and punctate cervical lymph node calcifications: sonographic features and utility of sonographically guided fine-needle aspiration biopsy.J Ultrasound Med. 2009; 28: 1703-1707
- Calcified nodal metastasis from squamous cell carcinoma of the head and neck.Australas Radiol. 2004; 48: 240-242
- Human papillomavirus testing in head and neck carcinomas: guideline from the College of American Pathologists.Arch Pathol Lab Med. 2018; 142: 559-597
- Human papillomavirus and cystic node metastasis in oropharyngeal cancer and cancer of unknown primary origin.PLoS One. 2014; 9e95364
- Association of cystic neck metastases and human papillomavirus-positive oropharyngeal squamous cell carcinoma.Arch Pathol Lab Med. 2009; 133: 1798-1803
- Tuberuclous lymph node calcification detected on routine panoramic radiography: an unusual case.J Oral Maxillofac Radiol. 2014; 2: 2
- Imaging appearance of granulomatous lesions of head and neck.Eur J Radiol. 2010; 76: 52-60
- Isolated cervical lymph node sarcoidosis presenting in an asymptomatic neck mass: a case report.Tuberc Respir Dis (Seoul). 2013; 75: 116-119
- Histoplasmosis presenting as isolated cervical lymphadenopathy: a rare presentation.J Cytol. 2015; 32: 188-190
- Validation of methods for oropharyngeal cancer HPV status determination in US cooperative group trials.Am J Surg Pathol. 2012; 36: 945-954
- Current status of clinical testing for human papillomavirus in oropharyngeal squamous cell carcinoma.J Pathol Clin Res. 2018; 4: 213-226
Article info
Publication history
Published online: October 04, 2021
Accepted:
September 21,
2021
Received in revised form:
September 13,
2021
Received:
July 13,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
