Cancer News

Guidelines for Human Papilloma Virus Testing in Head and Neck Carcinomas

CancerConnect News:  The Centers for Disease Control and Prevention estimates that in the United States, there are more than 16,000 individuals diagnosed with Human Papilloma Virus (HPV)-positive OroPharyngeal Squamous Cell Carcinoma (OPSCC) each year and there has been a significant increase over the past several decades.  Patients with HPV-positive OPSCC tend to be younger males, who are former smokers or nonsmokers, with risk factors for exposure to High Risk HPV (HR-HPV).

HPV-positive primary Squamous Cell Carcinoma tend to be smaller in size, with earlier spread to lymph nodes, and these patients have a better prognosis compared with patients with HPV-negative Head and Neck Squamous Cell Carcinoma.

Expression of tumor suppressor protein, known as p16, is highly correlated with infection with HPV in HNSCC. Accurate HPV assessment in head and neck cancers is becoming important as it significantly impacts clinical management, however there is currently no consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16, and which tests to choose.

The College of American Pathologists recently convened a panel of experts and following review of evidence from over 400 peer reviewed articles, came up with the following guidelines for testing. These guidelines are recommended for all new Oropharyngeal Squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
Guideline Summary

1) HPV testing should be performed on all patients with newly diagnosed OPSCC.

2) HPV testing should be performed by surrogate marker p16 ImmuHistoChemistry test and additional HPV-specific testing may be done at the discretion of the pathologist and/or treating clinician, or in the context of a clinical trial.

3) HPV testing by surrogate marker p16 IHC should be routinely performed on patients with metastatic Squamous Cell Carcinoma of unknown primary in a cervical upper or mid jugular chain lymph node.

4) HPV testing should be performed on all patients with known OPSCC not previously tested for HPV, with suspected OPSCC, or with metastatic SCC of unknown primary.

5) Pathologists should report p16 IHC positivity as a surrogate for HPV in tissue specimens when there is at least 70% nuclear and cytoplasmic expression with at least moderate to strong intensity.

6) HPV testing strategy should not be altered based on patient smoking history.

Reference: Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Lewis JS, Beadle B, Bishop JA, et al.

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