High-risk human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) exhibits distinctive clinical, pathologic, epidemiologic, and prognostic features. 1 Because of the better treatment response and survival profiles associated with HPV-associated versus HPV-independent OPSCC, the American Joint Committee on Cancer and Union for International Cancer Control staging systems currently risk stratify OPSCC differently, depending on high-risk HPV (HR-HPV) status. [2][3][4][5][6][7] Selected patients with HPV-mediated OPSCC may be eligible for clinical trials investigating less intensive treatment regimens relative to standardof-care surgery, radiotherapy, and/or chemotherapy protocols. 8-10 Therefore, HR-HPV status should be determined on the primary tumor or regional lymph node metastasis of all newly diagnosed OPSCC. 11 Different methodologies for HR-HPV-specific testing are available, including DNA-based polymerase chain reaction (PCR), 12,13 DNA-based in situ hybridization (ISH), 7,14,15 RNA-based quantitative reverse transcriptase-PCR, 16,17 and E6/E7 messenger RNA detection by ISH. 18,19 Immunohistochemistry (IHC) for p16 has emerged as a surrogate marker for HR-HPV in the oropharynx because it is widely available, shows excellent interobserver agreement, demonstrates reliable performance on small specimens, and is relatively affordable compared with HPV-specific molecular testing. 20,21 For histologic specimens of OPSCC, the College of American Pathologists (CAP) recommends p16 IHC as the primary testing modality for HPV status, with moderate-to-strong nuclear and cytoplasmic p16 staining in ≥70% of tumor cells considered a sensitive and reasonably specific threshold for transcriptionally active HR-HPV. 11,22 The recommendation for p16 and/or HR-HPV-specific testing also applies to fine-needle aspiration (FNA) biopsies of upper-jugular to mid-jugular (level II-III) neck lymph nodes with metastatic squamous cell carcinoma. Although CAP guidelines do not advise for or against any particular HPV testing method for FNA cytology samples, numerous studies have highlighted the lower sensitivity of p16 immunostaining for HR-HPV when interpretive criteria established for histology samples are applied to alcohol-fixed cell block material. [23][24][25][26][27][28][29] Accordingly, we routinely apply lower interpretive thresholds for p16 immunostaining and/or bypass p16 IHC altogether in favor of HR-HPVspecific testing for FNA cell block specimens prepared from CytoLyt. For patients with negative p16 and/or HR-HPV-specific testing results on FNA cytology material, repeat testing on subsequent histology specimens is recommended if a surgical or tissue biopsy sample becomes available. 11 Notably, the lower sensitivity of p16 staining in cell blocks has not been observed for aspirates collected directly into formalin, underscoring the importance of fixative and other preanalytic factors in interpreting this immunostain. 23 Although studies from the United Kingdom have recommended routine HR-HPV-specif...