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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Useful diagnostic information regarding HPV infection can be extracted from the CT appearance of OPSCC beyond what is apparent to the trained human eye.