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Diffusion Weighted Magnetic Resonance Imaging as a Biomarker to Determine Human Papilloma Virus Positivity in Oropharyngeal Squamous Cell Carcinoma. P J abehdar Maralani 1 , J Beelen 2 , D Patel 1 , D Enepekides 1 , K Higgins 1 , S Symons 1 , R Aviv 1

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  1. Diffusion Weighted Magnetic Resonance Imaging as a Biomarker to Determine Human Papilloma Virus Positivity in Oropharyngeal Squamous Cell Carcinoma P Jabehdar Maralani1,JBeelen2,DPatel1,DEnepekides1,KHiggins1,SSymons1,RAviv1 1University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, Canada 2The University of Western Ontario, London, ON, Canada

  2. No. No Disclosures.

  3. Introduction • There has been a recent increase in incidence of oropharyngeal squamous cell carcinoma (OSCC) believed to be due to human papilloma virus (HPV). • HPV positive (HPV+) OSCC has a much better prognosis compared to HPV negative (HPV-) disease and may benefit from deintensified treatment. • HPV+ OSSCs have larger and more cystic lymph nodes.

  4. Diffusion weighted imaging can quantitatively assess cell density. • We hypothesize that: HPV+ lymph nodes have more facilitated diffusion compared to HPV- lymph nodes and this can be used as an imaging biomarker to predict HPV positivity.

  5. Materials and Methods: • IRB approved with waiver of informed consent • Pretreatment MRIs of 22 HPV+ and 11 HPV- patients with pathology proven OSCC were retrospectively reviewed. • HPV status was determined by p16 immunostaining technique.

  6. Axial T1 pre-contrast images were coregistered with apparent diffusion coefficient (ADC) maps using SPM8 (Wellcome Trust Centre for Neuroimaging, UCL, UK). • Then, using Analyse 12.0 (Mayo Clinic, MN) the tumor and the largest ipsilateral level 2 lymph node were contoured separately to produce two volumes of interest (VOI) in each case.

  7. B A Examples of a region of interest drawn over a left sided OSCC (Panel A) and a right sided lymph node (Panel B)

  8. Maximum, minimum and average ADC values in each VOI as well as the volume of tumor and the volume of the ipsilateral level 2 lymph node were calculated and recorded in each case. • The results are expressed as average ± standard deviation. Two-tailed student t-test was used to compare average values.

  9. Results Table 1

  10. Table 2

  11. As demonstrated on table 2, there was a trend towards higher mean ADC values in HPV+ vs. HPV- lymph nodes (P=0.07). • There was also a trend towards larger volume of HPV+ vs. HPV- lymph nodes (P=0.08).

  12. Conclusion • There was a trend towards higher mean ADC values in HPV+ vs. HPV- lymph nodes representing more facilitated diffusion. This is consistent with more cystic changes in HPV+ nodes. • Diffusion weighted imaging can serve as a promising biomarker to predict HPV positivity in oropharyngeal squamous cell carcinoma. • Increased patient recruitment can increase the statistical power of this study which is already undergoing in our institution.

  13. References • Nakahira M, Saito N, Yamaguchi H et al. Use of quantitative diffusion-weighted magnetic resonance imaging to predict human papilloma virus status in patients with oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol. 2014: 271:1219-25 • Chaturvedi AK, Engels EA, Pfeiffer RM et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J ClinOncol 2011: 29:4294–4301 • Applebaum KM, Furniss CS, Zeka A et al. Lack of association of alcohol and tobacco with HPV16- associated head and neck cancer. 2007: J Natl Cancer Inst 99:1801–1810 • Rainsbury JW, Ahmed W, Williams HK et al. Prognostic biomarkers of survival in oropharyngeal squamous cell carcinoma: systematic review and meta-analysis. Head Neck. 2013: 35:1048-55

  14. Thank you

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