Accuracy of clinical staging for HPV-related oropharyngeal cancer and therapeutic implications

Introduction Cervical lymph node metastases are common at all stages of HPV-associated oropharyngeal cancer. While primary surgery with neck dissection provides definitive histopathological staging, determining potential adjuvant therapy, in case of primary radiation, clinical staging alone determines the extent of treatment to the neck . In this study, the results of pre-therapeutic radiographic neck staging were compared with the corresponding histopathological assement of tissue specimens in surgically treated HPV-associated oropharyngeal carcinoma patients to define the precision of clinical staging.

Methods Patients with HPV-positive oropharyngeal cancer and primary surgical therapy treated between 2017 and 2020 were included. Clinical neck staging results were retrospectively compared to the corresponding histopathological results. Clinical staging was retrospectively performed by a single neuroradiologist blinded to the pathological staging results. Clinical neck staging included radiographic characteristics for extracapsular extension of possible lymph node metastases.

Results 44 patients met the inclusion criteria. Histopathological N-stage differed from clinical N-stage in 31.8 %  of patients. Pathological upstaging (pN>cN) occurred in 11.4 %  of cases and downstaging (pN< cN) in 20.5 %  of cases. Extracapsular spread was detected radiologically with a specificity of 0.84 and a sensitivity of 0.58.

Discussion Compared to definitive pathology, clinical neck staging in patients with HPV-associated oropharyngeal carcinoma entails a degree of inaccuracy, which should be taken into consideration during therapy planning.

Publication History

Article published online:
13 May 2021