Ultrasonography-guided fine-needle aspiration with concurrent small core biopsy of neck masses and lymph nodes yields adequate material for HPV testing in head and neck squamous cell carcinomas

Allison, Derek B.; Miller, James A.; Coquia, Stephanie; Maleki, Zahra

doi:10.1016/j.jasc.2015.06.002

Cited by 33 publications

(39 citation statements)

References 22 publications

(13 reference statements)

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“…However, in the studies by Hou et al and Allison et al, p16 IHC was performed only in cases with “adequate” material (at least 100 tumor cells and an unspecified definition, respectively). In addition, Allison et al also included small core needle biopsy specimens in their cohort . Our results were more comparable to the sensitivity of 50% demonstrated by Xu et al, who included cases with scant cellularity; however, only 9% of cases within their cohort had <100 tumor cells, in comparison with 38% of the cases in our study cohort.…”

Section: Discussionsupporting

confidence: 84%

“…Overall, we found that the sensitivity for HPV was 93% when considering any p16 staining (≥1% cells) as a positive result, but was only 38% when using a cutoff value comparable to that used in the CAP guidelines for surgical specimens (ie, moderate to strong staining in ≥70% cells). Several previous studies have examined p16 IHC staining in cell blocks, although the cutoff value for p16 positivity was variable . Similar to our study, these also included nonoropharyngeal HNSCC and used other types of HPV testing (HPV DNA or RNA ISH) as a comparison in at least a subset of cases.…”

Section: Discussionmentioning

confidence: 97%

“…The concordance rate between p16 and HPV‐specific testing thus was not dependent on HPV testing in cell blocks. In addition, in these previous studies, only cervical lymph node metastases were evaluated, but in our cohort distant disease accounted for approximately 16% of cases. However, the presence of transcriptionally active HPV and p16 overexpression have been shown to be maintained throughout progression of disease, including in distant metastases, which in 1 study occurred 8 years after treatment of the primary tumor …”

Section: Discussionmentioning

confidence: 99%

“…This is potentially problematic for cytopathologists because current guidelines do not offer specific recommendations for the optimal HPV testing of cytology specimens. Although there have been a few studies to date that have examined p16 IHC in cell block material, results and criteria for p16 positivity have been variable . Therefore, the goal of this study was to evaluate p16 IHC in cell blocks of metastatic HPV‐HNSCC to further assess variables that impact staining results, with a secondary goal of determining the performance of HPV RNA ISH.…”

Section: Introductionmentioning

confidence: 99%

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Heterogeneity of p16 immunohistochemistry and increased sensitivity of RNA in situ hybridization in cytology specimens of HPV‐related head and neck squamous cell carcinoma

Wong

Krane

2019

Cancer Cytopathology

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Background Many patients with human papillomavirus (HPV)–related head and neck squamous cell carcinoma (HPV‐HNSCC) initially present with cervical lymph node metastases. Although p16 immunohistochemistry (IHC) is the most commonly used surrogate marker for HPV, however criteria in cytologic material are not well established. The objective of this study was to better characterize p16 IHC in cell blocks of metastatic HPV‐HNSCC, and to evaluate the performance of HPV RNA in situ hybridization (RNA ISH). Methods p16 IHC was performed on cell blocks from 97 metastatic HPV‐HNSCC fine‐needle aspiration specimens with HPV status confirmed by DNA or RNA ISH or polymerase chain reaction (PCR). Tumor cellularity (<100 cells, 100‐500 cells, and >500 cells) and quality (presence of cell clusters, necrosis) were recorded. p16 staining intensity and extent (1%‐9%, 10%‐69%, and ≥70%) were scored. In addition, RNA ISH was performed on 38 PCR‐positive cases. Results p16 IHC was positive in 90 of 97 cases (93%), demonstrating variable patterns. p16 staining was found to be moderate to strong in 69 cases, with 37 cases (38%) demonstrating positivity in ≥70% of tumor cells. Weak staining occurred in 21 cases (22%) and 7 cases (7%) were negative. Of the 60 cases with weak and/or absent expression or staining in <70% of cells, 30 cases (50%) had <100 tumor cells, 12 (20%) lacked cell clusters, and 19 cases (32%) had extensive necrosis. RNA ISH was positive in 37 of 38 cases (97%) that were HPV positive by PCR. Conclusions p16 is heterogeneous in cell blocks of metastatic HPV‐HNSCC, suggesting that any p16 positivity should prompt confirmatory HPV studies. RNA ISH appears to demonstrate high sensitivity, and laboratories even may consider using RNA ISH as a first‐line HPV test in cytologic specimens.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Heterogeneity of p16 immunohistochemistry and increased sensitivity of RNA in situ hybridization in cytology specimens of HPV‐related head and neck squamous cell carcinoma

Wong

Krane

2019

Cancer Cytopathology

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“…Several studies have successfully used DNA ISH on cytology specimens, both cell blocks and alcohol‐fixed aspirate smears . These studies utilized DNA probes specific for single HPV types (HPV16 and HPV18) as well as probes that can recognize a consensus sequence from a wide spectrum of HPV types.…”

Section: In‐situ Hybridization (Ish)mentioning

confidence: 99%

Fine‐needle aspiration biopsy of HPV‐related squamous cell carcinoma of the head and neck: Current ancillary testing methods for determining HPV status

Bernadt

Collins

2017

Diagnostic Cytopathology

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Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is a unique form of carcinoma that largely arises from the tonsillar tissue in the oropharynx. These tumors often present with cervical lymphadenopathy resulting in a fine needle aspiration (FNA) biopsy. Use of the cytology specimen to determine the HPV-status has significant prognostic and treatment implications as HPV-related tumors have a more favorable prognosis and response to nonsurgical therapies. While several different ancillary testing methods are available that have proven effective for determining HPV status in FNA specimens from HNSCCs, there is currently no consensus regarding HPV testing in this setting. Diagn. Cytopathol. 2017;45:221-229. © 2016 Wiley Periodicals, Inc.

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Identification of infectious organisms in cytopathology: A review of ancillary diagnostic techniques

Allison

Simner

Ali

2018

Cancer Cytopathology

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Cytology samples obtained from exfoliative sources and fine-needle aspiration (FNA) procedures can all be used to detect microorganisms and/or the associated cytopathologic effects (CPE) caused by an infection. There are many advantages to utilizing cytology samples as an adjunct to routine microbiology laboratory methods. For example, cytology samples can be obtained by non-invasive and minimally invasive techniques, and interpretation is affordable, accurate, and fast. Furthermore, routine cytology stains, including the Papanicolaou (Pap) and the Diff-Quik (DQ) stains, can adequately identify a number of microorganisms. Finally, material obtained by these procedures can also be used for cytologic ancillary testing, microbiology culture, and molecular studies. Currently, there are a variety of ancillary diagnostic techniques that are routinely utilized in the cytopathology laboratory. Additionally, the increasing utilization of molecular-based, diagnostic techniques on fluid specimens, as well as FFPE material, is expanding the role of cytopathology for infectious disease diagnostics. In this review, we provide an overview of the most practical ancillary techniques commonly used to identify microorganisms on cytology specimens.

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Ultrasonography-guided fine-needle aspiration with concurrent small core biopsy of neck masses and lymph nodes yields adequate material for HPV testing in head and neck squamous cell carcinomas

Cited by 33 publications

References 22 publications

Heterogeneity of p16 immunohistochemistry and increased sensitivity of RNA in situ hybridization in cytology specimens of HPV‐related head and neck squamous cell carcinoma

Heterogeneity of p16 immunohistochemistry and increased sensitivity of RNA in situ hybridization in cytology specimens of HPV‐related head and neck squamous cell carcinoma

Fine‐needle aspiration biopsy of HPV‐related squamous cell carcinoma of the head and neck: Current ancillary testing methods for determining HPV status

Identification of infectious organisms in cytopathology: A review of ancillary diagnostic techniques

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