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Calcified lymph nodes in the setting of head and neck squamous cell carcinoma: A predictor of HPV positivity?

  • Author Footnotes
    1 Advocate Illinois Masonic Medical Center, 836 Wellington Ave, Chicago, IL 60657, United States of America.
    Parinda H. Shah
    Footnotes
    1 Advocate Illinois Masonic Medical Center, 836 Wellington Ave, Chicago, IL 60657, United States of America.
    Affiliations
    Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
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  • Author Footnotes
    2 NorthShore Medical Group, 2650 Ridge Ave, Evanston, IL 60201, United States of America.
    Achilles G. Karagianis
    Footnotes
    2 NorthShore Medical Group, 2650 Ridge Ave, Evanston, IL 60201, United States of America.
    Affiliations
    Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
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  • Author Footnotes
    3 Norton Hospital, 200 E Chestnut St, Louisville, KY 40202, United States of America.
    Malisa S. Lester
    Footnotes
    3 Norton Hospital, 200 E Chestnut St, Louisville, KY 40202, United States of America.
    Affiliations
    Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
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  • Author Footnotes
    2 NorthShore Medical Group, 2650 Ridge Ave, Evanston, IL 60201, United States of America.
    Ajit S. Paintal
    Footnotes
    2 NorthShore Medical Group, 2650 Ridge Ave, Evanston, IL 60201, United States of America.
    Affiliations
    Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
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  • Author Footnotes
    4 Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America.
    Erin N. McComb
    Correspondence
    Corresponding author at: 676 N. St. Clair Street, Suite 1400, Chicago, IL 60611, United States of America.
    Footnotes
    4 Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America.
    Affiliations
    Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America
    Search for articles by this author
  • Author Footnotes
    1 Advocate Illinois Masonic Medical Center, 836 Wellington Ave, Chicago, IL 60657, United States of America.
    2 NorthShore Medical Group, 2650 Ridge Ave, Evanston, IL 60201, United States of America.
    3 Norton Hospital, 200 E Chestnut St, Louisville, KY 40202, United States of America.
    4 Northwestern Memorial Hospital, 676 N St Clair, Suite 800, Chicago, IL 60611, United States of America.

      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

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      References

        • You E.L.
        • Henry M.
        • Zeitouni Zeitouni A.G.
        Human papillomavirus-associated oropharyngeal cancer: review of current evidence and management.
        Curr. Oncol. 2019; 26: 119-123
        • Pytynia K.B.
        • Dahlstrom K.R.
        • Sturgis E.M.
        Epidemiology of HPV-associated oropharyngeal cancer.
        Oral Oncol. 2014; 50: 380-386
        • Economopoulou P.
        • Kotsantis I.
        • Psyrri A.
        Special issue about head and neck cancers: HPV positive cancers.
        Int J Mol Sci. 2020; 21: 3388
        • Goldenberg D.
        • Begum S.
        • Westra W.H.
        • et al.
        Cystic lymph node metastasis in patients with head and neck cancer: an HPV-associated phenomenon.
        Head Neck. 2008; 30: 898-903
        • Huang Y.H.
        • Yeh C.H.
        • Cheng N.M.
        • et al.
        Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: relationship with human papillomavirus status and failure patterns.
        PLoS One. 2017; 12e0180779
        • Rath T.J.
        • Narayanan S.
        • Hughes M.A.
        • et al.
        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
        • Hoang J.K.
        • Vanka J.
        • Ludwig B.J.
        • et al.
        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
        • Eisenkraft B.L.
        • Som P.M.
        The spectrum of benign and malignant etiologies of cervical node calcification.
        AJR Am J Roentgenol. 1999; 172: 1433-1437
        • Shin L.K.
        • Fischbein N.J.
        • Kaplan M.J.
        • et al.
        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
        • Gormly K.
        • Glastonbury C.M.
        Calcified nodal metastasis from squamous cell carcinoma of the head and neck.
        Australas Radiol. 2004; 48: 240-242
        • Lewis Jr., J.S.
        • Beadle B.
        • Bishop J.A.
        • et al.
        Human papillomavirus testing in head and neck carcinomas: guideline from the College of American Pathologists.
        Arch Pathol Lab Med. 2018; 142: 559-597
        • Yasui T.
        • Morii E.
        • Yamamoto Y.
        • et al.
        Human papillomavirus and cystic node metastasis in oropharyngeal cancer and cancer of unknown primary origin.
        PLoS One. 2014; 9e95364
        • McHugh J.B.
        Association of cystic neck metastases and human papillomavirus-positive oropharyngeal squamous cell carcinoma.
        Arch Pathol Lab Med. 2009; 133: 1798-1803
        • Gunduz K.
        • Canitezer G.
        • Avsever H.
        Tuberuclous lymph node calcification detected on routine panoramic radiography: an unusual case.
        J Oral Maxillofac Radiol. 2014; 2: 2
        • Razek A.A.
        • Castillo M.
        Imaging appearance of granulomatous lesions of head and neck.
        Eur J Radiol. 2010; 76: 52-60
        • Kwon Y.S.
        • Jung H.I.
        • Kim H.J.
        • et al.
        Isolated cervical lymph node sarcoidosis presenting in an asymptomatic neck mass: a case report.
        Tuberc Respir Dis (Seoul). 2013; 75: 116-119
        • Mishra D.P.
        • Ramamurthy S.
        • Behera S.K.
        Histoplasmosis presenting as isolated cervical lymphadenopathy: a rare presentation.
        J Cytol. 2015; 32: 188-190
        • Jordan R.C.
        • Lingen M.W.
        • Perez-Ordonez B.
        • et al.
        Validation of methods for oropharyngeal cancer HPV status determination in US cooperative group trials.
        Am J Surg Pathol. 2012; 36: 945-954
        • Kim K.Y.
        • Lewis Jr., J.S.
        • Chen Z.
        Current status of clinical testing for human papillomavirus in oropharyngeal squamous cell carcinoma.
        J Pathol Clin Res. 2018; 4: 213-226