Computed Tomography-Based Texture Analysis to Determine Human Papillomavirus Status of Oropharyngeal Squamous Cell Carcinoma

To determine whether machine learning can accurately classify human papillomavirus (HPV) status of oropharyngeal squamous cell carcinoma (OPSCC) using computed tomography (CT)-based texture analysis. Texture analyses were retrospectively applied to regions of interest from OPSCC primary tumors on contrast-enhanced neck CT, and machine learning was used to create a model that classified HPV status with the highest accuracy. Results were compared against the blinded review of 2 neuroradiologists. The HPV-positive (n = 92) and -negative (n = 15) cohorts were well matched clinically. Neuroradiologist classification accuracies for HPV status (44.9%, 55.1%) were not significantly different (P = 0.13), and there was a lack of agreement between the 2 neuroradiologists (κ = -0.145). The best machine learning model had an accuracy of 75.7%, which was greater than either neuroradiologist (P < 0.001, P = 0.002). Useful diagnostic information regarding HPV infection can be extracted from the CT appearance of OPSCC beyond what is apparent to the trained human eye.