What question did this study set out to answer?

This study aims to assess the relationship between normalized iodine concentration and histopathological characteristics in head and neck squamous cell carcinoma.

June 2, 2026Journal of Cancer Research and Clinical Oncology0 citationsOpen Access

Photon counting computed tomography in head and neck squamous cell carcinoma: iodine concentration and histopathological features

ASAlexey SurovUniversity Hospitals of the Ruhr-University of Bochum RDRaihanatou Diallo-DanebrockJohannes Wesling Klinikum Minden HSHagen SonnemannUniversity Hospitals of the Ruhr-University of Bochum

Key Points

This study aims to assess the relationship between normalized iodine concentration and histopathological characteristics in head and neck squamous cell carcinoma.
Eighty-four patients with primary untreated head and neck squamous cell carcinoma underwent contrast-enhanced photon-counting computed tomography.
Iodine maps calculated intratumoral iodine concentration, normalized to aortal iodine concentration.
Histopathological analysis included tumor stage, grade, Ki 67 index, tumor cell count, and HPV status.
Normalized iodine concentration demonstrated excellent interreader reliability (ICC = 0.96, 95% CI = (0.92; 0.98), p < 0.01).
Lower normalized iodine concentration was associated with higher tumor cell count (r = -0.24, p = 0.03).
A threshold of ≥ 0.5 for normalized iodine concentration predicted HPV negative tumors with 54.5% sensitivity and 94.4% specificity (AUC = 0.74, 95% CI = 0.62–0.86, p < 0.01).

Abstract

Abstract Purpose Head and neck squamous cell carcinoma (HNSCC) is a common malignancy with increasing relevance in oncologic imaging. Photon-counting computed tomography (PCCT) allows for quantitative assessment in iodine concentration (IC) offering new insights into tumor biology. This study aimed to investigate the association between normalized IC (NIC) and histopathological features in HNSCC. Methods Eighty-four patients with primary untreated HNSCC underwent contrast-enhanced PCCT of the neck in venous phase. Iodine maps were generated to quantify intratumoral IC. NIC was calculated as the ratio of tumoral IC to aortal IC. Histopathological analysis included tumor stage, tumor grade, Ki 67 proliferation index, tumor cell count and human papillomavirus (HPV) status. Group comparison were conducted using Mann-Whitney-U tests. Interreader agreement was assessed via intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance of NIC for HPV status. Results NIC values demonstrated excellent interreader reliability (ICC = 0.96, 95%CI = (0.92; 0.98), p < 0.01). NIC showed an inverse correlation with tumoral cell count ( r = -0.24, p = 0.03). Tumors with lymphonodal metastases exhibited lower NIC values compared to N0 tumors (0.42 ± 0.20 vs. 0.54 ± 0.26, p = 0.02). Cell-rich tumors had lower NIC values than cell-poor tumors (0.42 ± 0.18 vs. 0.53 ± 0.26, p = 0.003). HPV negative tumors showed higher NIC values than HPV-positive tumors (0.51 ± 0.23 vs. 0.33 ± 0.18, respectively, p < 0.01). A NIC threshold of ≥ 0.5 predicted HPV negative tumors, demonstrating 54.5% sensitivity and 94.4% specificity, with an AUC of 0.74 (95% CI = 0.62–0.86, p < 0.01). Conclusions NIC derived from PCCT is a robust and reproducible imaging parameter in HSNCC. It is moderately associated with tumor cellularity, nodal involvement, and HPV status. Thus, NIC may serve as a valuable adjunct in non-invasive tumor characterization.

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