Certain head and neck cancers that are positive for high-risk types of human papillomavirus have a better prognosis and may need less aggressive treatment.
To help ensure that patients with these cancers are accurately diagnosed and effectively treated, the College of American Pathologists released its newest evidence-based practice guideline, “Human Papillomavirus Testing in Head and Neck Carcinomas,” now available in Archives of Pathology and Laboratory Medicine.
An interdisciplinary, expert panel of pathologists, surgeons, radiation oncologists, medical oncologists, patients, and patient advocates developed the guideline, which recommends accurate assessments of a patient’s high-risk HPV status, directly or by surrogate markers.
Based on a screening of 2,200 peer-reviewed articles and a review of evidence from 492 studies, the panel issued 14 final recommendations in the guideline. Notably:
High-risk HPV testing should be performed on all patients with newly diagnosed oropharyngeal squamous cell carcinoma, including all histologic subtypes.
HR-HPV testing should NOT be routinely performed on nonsquamous carcinomas of the oropharynx, nor on nonoropharyngeal primary carcinomas of the head and neck.
Because marked overexpression of the tumor suppressor protein p16 is strongly associated with transcriptionally-active high-risk HPV, pathologists should perform HR-HPV testing by surrogate marker p16 immunohistochemistry on oropharyngeal tissue specimens. Additional HPV-specific testing may be done at the discretion of the pathologist, treating clinician, or in the context of a clinical trial.
For HPV-positive/p16 cases, tumor grade (or differentiation status) is not recommended. Resources to implement the new guideline are available on cap.org.
