MRI for Differentiation between HPV-Positive and HPV-Negative Oropharyngeal Squamous Cell Carcinoma: A Systematic Review.

Simple Summary: Human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) has a different disease course compared to HPV-negative (HPV−) OPSCC. This systematic review aims to investigate whether magnetic resonance imaging (MRI) can discriminate between HPV+ and HPV− OPSCC or predict HPV status in OPSCC patients using MRI. Our results show that parameters derived from structural MRI and diffusion-weighted MRI are able to discriminate between HPV+ and HPV− cases and predict HPV status with reasonable accuracy. Other MRI sequences have yet to prove their added value for the discrimination and prediction of HPV status in OPSCC patients. Machine learning studies that compared predictive models with and without clinical variables found that performance improved significantly when clinical variables were included in the model. Before the clinical implementation of MRI for HPV status determination, larger studies with external model validation using independent datasets are needed. Human papillomavirus (HPV) is an important risk factor for oropharyngeal squamous cell carcinoma (OPSCC). HPV-positive (HPV+) cases are associated with a different pathophysiology, microstructure, and prognosis compared to HPV-negative (HPV−) cases. This review aimed to investigate the potential of magnetic resonance imaging (MRI) to discriminate between HPV+ and HPV− tumours and predict HPV status in OPSCC patients. A systematic literature search was performed on 15 December 2022 on EMBASE, MEDLINE ALL, Web of Science, and Cochrane according to PRISMA guidelines. Twenty-eight studies (n = 2634 patients) were included. Five, nineteen, and seven studies investigated structural MRI (e.g., T1, T2-weighted), diffusion-weighted MRI, and other sequences, respectively. Three out of four studies found that HPV+ tumours were significantly smaller in size, and their lymph node metastases were more cystic in structure than HPV− ones. Eleven out of thirteen studies found that the mean apparent diffusion coefficient was significantly higher in HPV− than HPV+ primary tumours. Other sequences need further investigation. Fourteen studies used MRI to predict HPV status using clinical, radiological, and radiomics features. The reported areas under the curve (AUC) values ranged between 0.697 and 0.944. MRI can potentially be used to find differences between HPV+ and HPV− OPSCC patients and predict HPV status with reasonable accuracy. Larger studies with external model validation using independent datasets are needed before clinical implementation. [ABSTRACT FROM AUTHOR]