“…For the reference standard, the main concern was the use of different HPV determination methods for different patients or the exclusive use of p16 immunohistochemistry for HPV determination [ 20 , 21 , 22 , 23 , 26 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The main concern for patient selection was the lack of information on consecutive or random patient selection and the exclusion of patients with lower-stage OPSCC [ 20 , 25 , 27 , 35 , 36 , 37 , 38 , 39 , 45 , 46 , 47 ]. Regarding the index test, the main concern was the lack of pre-specification of thresholds or independent validation [ 21 , 25 , 26 , 27 , 31 , 39 , 40 , 41 , 46 , 47 , 48 ].…”