HPV Specific Testing: A Requirement for Oropharyngeal Squamous Cell Carcinoma Patients

Abstract

Human papillomavirus (HPV) testing is now recommended as part of the work up for patients with oropharyngeal squamous cell carcinoma (OPSCC) and those patients with cervical lymph node metastasis of unknown origin. The laboratory testing strategy should accurately assess the presence or absence of oncogenic HPV infection in routinely collected tumour samples that are subject to standard fixation protocols, alcohol-fixed cytological preparations and formalin-fixed tissue samples. The HPV status should correlate with biologically relevant outcome measures such as overall, disease-specific and disease-free survival. Whilst increased expression of p16 by immunohistochemistry is considered to be a surrogate marker of oncogenic HPV infection and is a validated independent prognostic biomarker, only HPV specific tests provide definitive evidence of the aetiological agent. We provide an overview of HPV testing in OPSCC, justifying the use of HPV specific tests. We examine the analytical accuracy of HPV specific tests against the 'reference' test--high risk HPV mRNA in fresh tissue--and contrast this with the performance of p16 immunohistochemistry as a stand alone test. We highlight the added value of HPV specific tests in prognostication, clinical trial design, and population-based disease surveillance. We consider that HPV specific testing is the starting point for developing increasingly informative biomarker panels in the context of 'stratified medicine'. We briefly frame test information in the context of disclosure of HPV status to patients. We conclude that only a testing strategy that includes HPV specific tests can deliver more effective care for patients with OPSCC. The international head and neck oncology community should work together to clearly define the minimum requirements for assigning a diagnosis of HPV-related OPSCC in order to ensure consistent reporting of this emerging and increasingly prevalent disease.

Changes in Epidermal Growth Factor Receptor Gene Copy Number during Oral Carcinogenesis

“…Furthermore, it is unclear how criteria validated for interpretation of EGFR GCN signals in non-small cell lung carcinoma should be applied to oral cancer. It is well documented that detection of high-risk human papillomavirus (HPV) by p16 immunohistochemistry (IHC) and ISH is significant in the prognostication of oropharyngeal squamous cell carcinoma (35)(36)(37). The current study was restricted to the examination of potentially malignant disorders/squamous cell carcinoma of the oral cavity and excluded oropharyngeal subsites.…”

Knowledge of human papillomavirus (HPV) testing in the USA, the UK and Australia: an international survey

“…As HPV testing is now being widely used in cervical screening, and may be introduced in the context of other HPV-related cancers in the future,19 assessing awareness and knowledge of HPV testing is important to identify information needs in women and men. Addressing these needs could help women and men to understand their results and minimise anxiety and distress associated with HPV testing results.…”

Degenerated Keratinized Tumor Cells in Oropharyngeal Human Papilloma Virus-Associated Squamous Cell Carcinoma: A Pitfall in p16 Immunostaining of Fine-Needle Aspiration Specimens

“…It needs to be stressed that positive p16 by immunostaining is a surrogate marker of oncogenic HPV infection, and only HPV-specific tests provide definitive evidence [4,11,21]. Recently Bishop et al [22] found that the HPV-PCR (Hybrid Capture II) test correlated with p16 immunohistochemistry and HR-HPV in situ hybridization using FNA specimens.…”