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J Nucl Med. 2014 Mar;55(3):431-8. doi: 10.2967/jnumed.113.125542. Epub 2014 Jan 9.

PET/CT imaging and human papilloma virus-positive oropharyngeal squamous cell cancer: evolving clinical imaging paradigm.

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  • 1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.


Human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) represents an emerging disease that differs from HPV-negative OPSCC in natural history and prognosis. Contrast-enhanced PET/CT is essential to accurately stage the primary site when there are smaller tumors; neck nodal metastases, which tend to have a more cystic component; and distant metastases that manifest in unusual sites (disseminating phenotype) such as bones and other solid organs, including brain. Metastases tend to appear later in the disease course during follow-up for HPV-positive OPSCC than for HPV-negative OPSCC. Because HPV-positive OPSCC patients have a better clinical outcome, there is a need for treatment deintensification to spare the patient from treatment-related toxicities. (18)F-FDG PET/CT would play a role in monitoring patients with deintensified treatments to ensure that no adverse outcome is introduced. The better prognosis and outcome of HPV-positive OPSCC patients would warrant imaging follow-up that is less intense but continues longer because of the manifestation of distant metastases later in the disease course and at unusual sites. All these clinical paradigms facilitate a definite role for PET/CT imaging in the management of HPV-positive OPSCC.


HPV; OPSCC; PET/CT; general oncology

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