, Volume 61, Issue 12, pp 1415–1424 | Cite as

Discrimination of HPV status using CT texture analysis: tumour heterogeneity in oropharyngeal squamous cell carcinomas

  • Ji Young Lee
  • Miran HanEmail author
  • Kap Seon Kim
  • Su-Jin Shin
  • Jin Wook Choi
  • Eun Ju Ha
Head-Neck-ENT Radiology



To evaluate the diagnostic performance of texture analysis for discriminating human papillomavirus (HPV) status in patients with oropharyngeal squamous cell carcinoma (OPSCC) in the primary tumours and metastatic lymph nodes.


Ninety-five patients with primary tumour and 91 with metastatic lymph nodes with confirmed HPV status, who underwent pretreatment contrast-enhanced CT (CECT), were included as the discovery population. CT texture analysis was performed using commercially available software. Differences between HPV-positive and HPV-negative groups were analysed using the χ2 test (or Mann-Whitney U test) and independent t test (or Fisher’s exact test). ROC curve analysis was performed to discriminate HPV status according to heterogeneity parameters. Diagnostic accuracy was evaluated in the separate validation population (n = 36) from an outside hospital.


HPV positivity was 52.6% for primary tumours and 56.0% for metastatic lymph nodes. The entropy and standard deviation (SD) values in the HPV-positive group were significantly lower. Entropy using the medium filter was the best discriminator between HPV-positive and HPV-negative primary OPSCCs (AUC, 0.85) and SD without the filter for metastatic lymph nodes (AUC, 0.82). Diagnostic accuracy of entropy for the primary tumour was 80.0% in the discovery group and 75.0% in the validation group. In cases of metastatic lymph node, the accuracy of SD was 79.1% and 78.8%, respectively.


Significant differences were found in heterogeneity parameters from texture analysis of pretreatment CECT, according to HPV status. Texture analysis could be used as an adjunctive tool for diagnosis of HPV status in clinical practice.


Squamous cell carcinoma Oropharyngeal cancer Human papilloma virus Computed tomography 


Funding information

The authors state that this work has not received any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this retrospective study, formal consent is not required.

Informed consent

Written informed consent was waived by the Institutional Review Board. Institutional Review Board approval was obtained (AJIRB-MED-MDB-18-235 and HYUH 2018-08-015)

Supplementary material

234_2019_2295_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 23 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of RadiologyHanyang University Medical CenterSeoulRepublic of Korea
  2. 2.Department of Radiology, Ajou University School of MedicineAjou University Medical CenterSuwonRepublic of Korea
  3. 3.Department of PathologyHanyang University Medical CenterSeoulRepublic of Korea

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