Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus–Associated Oropharyngeal Cancer

Yin, Linda X.; Karp, Emily E.; Elias, Anna J.; O’Byrne, Thomas J.; Routman, David M.; Price, Daniel L.; Kasperbauer, Jan L.; Neben-Wittich, M.A.; Chintakuntlawar, Ashish V.; Price, Katharine A.; Daniel, J.; Foote, Robert L.; Moore, Eric J.; Abel, Kathryn M. Van

doi:10.1177/01945998211000426

Cited by 7 publications

(7 citation statements)

References 30 publications

(61 reference statements)

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“…[21][22][23] Significant delays in HPV(+) OPSCC diagnosis have been associated with increased clinical stage at presentation, but delays in diagnosis up to 1 year were not found to change oncologic outcomes including overall survival, disease specific survival, and progression free survival. 24 HPV(À)OPSCC disease is known to be more aggressive with worse clinical stage at presentation and worse oncologic outcomes. Thus, further investigation into the implication of delay in diagnosis with regards to staging, treatment, and oncologic outcomes is warranted.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically in HNC, delay in definitive treatment is associated with tumor progression and upstaging potentially leading to more aggressive treatment and poorer outcomes 21–23 . Significant delays in HPV(+)OPSCC diagnosis have been associated with increased clinical stage at presentation, but delays in diagnosis up to 1 year were not found to change oncologic outcomes including overall survival, disease specific survival, and progression free survival 24 . HPV(−)OPSCC disease is known to be more aggressive with worse clinical stage at presentation and worse oncologic outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

et al. 2022

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Objective: Failure to recognize symptoms of non-human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPV(À)OPSCC) at presentation can delay diagnosis and treatment. We aim to identify patient factors and provider practice patterns that delay presentation and care in HPV(À)OPSCC.Methods: Retrospective review at a tertiary care center. Patients with HPV(À)OPSCC receiving treatment from 2006 to 2016. Patients were excluded if their date of symptom onset or diagnosis was unknown after thorough review of the electronic medical record or their tissue was not tested for HPV or p16. Clinical data, workup, and care timelines were abstracted. Univariate and multivariable linear regressions were performed to determine associations between patient and provider factors and delays in care.Results: Of 70 included patients, 52 (74%) were male and mean age was 60.5 (SD = 9.0). Median time to diagnosis was 69 days (IQR = 32-127 days), with a median latency of 30 days (IQR = 12-61 days) from symptom onset to first presentation and 19.5 days (IQR = 4-46 days) from the first presentation to diagnosis. Most patients visited at least 2 providers (n = 52, 74%) before diagnosis. Evaluation by 3 or more providers prior to diagnosis was associated with significant delays in diagnosis of nearly a year (357.7 days, p < 0.001) and being treated or prescribed analgesia prior to diagnosis was significantly associated with delays in diagnosis (p = 0.004) on univariate regression analysis.Conclusions: Delays in care related to evaluations by multiple providers and misdiagnosis prolonged time to diagnosis in HPV(À)OPSCC. Improved patient and provider education is necessary to expedite the diagnosis of HPV(À)OPSCC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

et al. 2022

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“…Although delays in diagnosis may not directly affect oncologic outcomes in HPV(+)OPSCC, patients who require multiple diagnostic tests to reach a diagnosis may suffer increased illness anxiety, discomfort related to the procedure, and financial morbidity from additional tests or consultations required to achieve a diagnosis. In addition, a false negative biopsy may give patients and providers a false sense of security 2,21 . An argument for observation or repeat antibiotic trials could be made for an asymptomatic, historically low risk patient with no evidence of a primary tumor on imaging or physical exam and a negative or indeterminate FNA biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, a false negative biopsy may give patients and providers a false sense of security. 2,21 An argument for observation or repeat antibiotic trials could be made for an asymptomatic, historically low risk patient with no evidence of a primary tumor on imaging or physical exam and a negative or indeterminate FNA biopsy. This is not supported by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines, however, which recommend pursuing further evaluation of a neck mass without a known diagnosis and an infectious workup only in patients with infectious symptoms.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Biopsy in Patients With HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

et al. 2022

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Objectives To identify the differences in sensitivity and accuracy between ultrasound‐guided and palpation‐guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. Study Design Retrospective chart review. Materials and Methods A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006–12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi‐square and Fisher exact tests. Results A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation‐guided FNAs, 160 (77%) ultrasound‐guided FNAs, and 18 (9%) ultrasound‐guided FNA + core biopsies. Sensitivity was significantly different among palpation‐guided FNA, ultrasound‐guided FNA, and ultrasound‐guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound‐guided FNA versus ultrasound‐guided FNA + core biopsies (P = .31). Conclusion The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. Level of Evidence 3 Laryngoscope, 132:2396–2402, 2022

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“…6 Additionally, patients with HPVþ OPSCC who were diagnosed at >12 months from symptom onset were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation than patients diagnosed < 12 months from symptom onset. 7 The aim of the present study was to further characterize HPVþ OPSCC by assessing for the presence of diagnostic delay compared with HPV-OPSCC and evaluating the role of various management factors that potentially impact time to diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

McGarey,

Hamdi,

Donaldson

et al. 2024

Int Arch Otorhinolaryngol

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Introduction Human papillomavirus-related (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation. Objective The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis. Methods Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002–2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis. Results p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-; p < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-; p < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed; p = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-; p = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-, p = 0.03). Conclusions Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment.

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Disease Profile and Oncologic Outcomes After Delayed Diagnosis of Human Papillomavirus–Associated Oropharyngeal Cancer

Cited by 7 publications

References 30 publications

Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

Diagnostic Delay in Human Papillomavirus Negative Oropharyngeal Squamous Cell Carcinoma

Ultrasound Guided Biopsy in Patients With HPV‐Associated Oropharyngeal Squamous Cell Carcinoma

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

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