HPV-related oropharyngeal squamous cell carcinoma and radiomics: a new era?

The increase of the incidence of Human Papilloma Virus (HPV) dependent oropharyngeal squamous cell carcinoma (OPSCC) is alarming, although we have greatly progressed in the classification and staging of this disease. We now know that OPSCC-HPV+ is a sub-type of head and neck squamous cell carcinoma with favourable prognosis and good response to therapy that needs a proper system of classification and staging. Thus, in routine practice it is essential to test patients for the presence of HPV. The most popular technique to assess HPV status is immunohistochemistry on biopsy samples with p16, which is an excellent surrogate for high-risk HPV infection. Another highly sensitive and specific tissue-based technique for the detection of HPV is RNAscope In Situ Hybridization (ISH) that has a prohibitive cost, limiting its use in routine practice. Radiomic is an artificial intelligence based non-invasive method of computational analysis of computed tomography, magnetic resonance imaging, positron emission tomography, and ultrasound images. A growing body of evidence suggest that radiomics is able to characterise and detect early relapse after treatment, and enable development of tailored therapy of HPV-positive OPSCC. In this review, we summarise the last findings of radiomic applied to HPV-associated OPSCC.