Relationships between apparent diffusion coefficient (ADC) histogram analysis parameters and PD-L 1-expression in head and neck squamous cell carcinomas: a preliminary study

Background. Immunotherapy has become a cornerstone of the modern cancer treatment. It might be crucial to predict its expression non-invasively by imaging. The present study used diffusion-weighted imaging (DWI) quantified by whole lesion apparent diffusion coefficient (ADC) values to elucidate possible associations with programmed cell death ligand 1(PD-L1) expression in head and neck squamous cell cancer (HNSCC). Patients and methods. Overall, 29 patients with primary HNSCC of different localizations were involved in the study. DWI was obtained by using a sequence with b-values of 0 and 800 s/mm(2) on a 3 T MRI. ADC values were evaluated with a whole lesion measurement and a histogram approach. PD-L1 expression was estimated on bioptic samples before any form of treatment using 3 scores, tumor positive score (TPS), immune cell score (ICS), and combined positive score (CPS). Results. An inverse correlation between skewness derived from ADC values and ICS was identified (r = -0.38, p = 0.04). ADC(max) tended to correlate with ICS (r = -0.35, p = 0.06). Other ADC parameters did not show any association with the calculated scores. Conclusions. There is a weak association between skewness derived from ADC values and PD-L1 expression in HNSCC, which might not be strong enough to predict PD-L1 expression in clinical routine. Presumably, ADC values are more influenced by complex histopathology compartments, comprising cellular and extracellular aspects of tumors than only of a single subset of tumor associated cells.

Automated summary

This study used diffusion-weighted imaging (DWI) to quantify the whole lesion apparent diffusion coefficient (ADC) values and found a weak association between skewness derived from ADC values and programmed cell death ligand 1 (PD-L1) expression in head and neck squamous cell cancer (HNSCC). The maximum ADC value tended to correlate with immune cell score (ICS). Other ADC parameters did not show any significant associations with PD-L1 expression.