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Accuracy of pre-, and posttreatment imaging of head and neck cancers, with special regard to HPV associated oropharyngeal cancers

hungarian

Horváth Angéla

Clinical Medicine

Dr. Fekete Andrea

SE Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika tanterem

2026-11-25 14:00:00

Otorhinolaryngology

Dr. Dr. Tamás László

Kornél Pál Dr. Dános

Dr. Végh Dániel Csaba

Dr. Burián András

Dr. Lakatos Péter

Dr. Mühl Dorottya

Dr. Sztanó Balázs

Introduction: Accurate diagnosis is essential in HNSCC, particularly in HPV-associated OPSCC, which differs from HPV-negative disease in clinical behavior and imaging characteristics. This dissertation evaluated pre- and posttreatment imaging in HNSCC, focusing on nodal assessment, PET/CT-derived metabolic parameters in relation to p16/HPV status and PD-L1 expression, and the clinical significance of patient delay. Methods: Four studies were included. Patient delay was analyzed retrospectively in 236 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Preoperative imaging and FNAC were compared with histopathology in 62 surgically treated patients. Posttreatment FDG-PET/CT was prospectively evaluated in 58 node-positive HNSCC patients after chemoradiotherapy. Finally, 60 newly diagnosed OPSCC patients were analyzed for associations between PET/CT-derived metabolic parameters, PD-L1 expression, p16/HPV status, survival, and treatment response. Results: Hungarian HNSCC patients showed a relatively long patient delay (mean 17.57 weeks), but delay did not significantly influence survival. In OPSCC, delay duration was similar in p16-positive and p16-negative cases, whereas symptoms and survival differed. Preoperative imaging and FNAC were clinically useful but limited in excluding nodal metastases, with false-negative rates of 26.1% and 33.3%. Posttreatment FDG-PET/CT showed high overall diagnostic accuracy, especially for ruling out residual nodal disease (NPV 97%); however, in p16-positive OPSCC, false-positive findings were more frequent, resulting in a PPV of 43%. In OPSCC, primary tumor TLG was independently associated with survival, primary tumor MTV was associated with complete remission after chemoradiotherapy, and in HPV-associated disease, volumetric PET parameters correlated positively with PD-L1 expression. Conclusion: Patient delay was relatively long, supporting the need for patient education and earlier symptom recognition, although it did not independently determine survival. Conventional preoperative imaging and FNAC cannot reliably exclude cervical metastases, whereas posttreatment PET/CT is most valuable for ruling out residual nodal disease, with positive findings in HPV-associated OPSCC requiring caution. PET/CT-derived metabolic parameters may provide prognostic, predictive, and immune-related information, supporting more accurate risk stratification and individualized treatment planning.