Role of Cytology in the Diagnosis and Management of HPV-Associated Head and Neck Carcinoma

Krane, Jeffrey F.

doi:10.1159/000346715

Cited by 55 publications

(58 citation statements)

References 151 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…HPV detection in this cytologic material can be performed indirectly through p16 immunohistochemistry on cell-blocks or with direct methods of identifying HR HPV DNA utilizing PCR analysis or in situ hybridization. [12151617] Until date, there is no consensus as to which of these is the best method for testing for HPV in cytology specimens.…”

Section: Discussionmentioning

confidence: 99%

Adequacy of fine-needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma

et al. 2013

View full text Add to dashboard Cite

Background:Head and neck squamous cell carcinoma is often associated with human papillomavirus (HPV) infection. Positive HPV status has been associated with increased response to treatment and improved prognosis in terms of recurrence-free and overall survival. In certain instances, diagnosis is performed through fine-needle aspiration of lymph nodes with metastatic carcinoma, often demonstrating extensive tumor necrosis. We evaluated the effect of tumor necrosis on deoxyribonucleic acid (DNA) adequacy for HPV molecular testing.Materials and Methods:Retrospective review of the pathology files at our institution identified cases of squamous cell carcinoma (SCC) diagnosed by fine-needle aspiration (FNA) on which HPV DNA molecular testing was performed. The cases were classified according to percent tumor necrosis into three categories (<10% necrosis, 10-70% necrosis and >70% necrosis) and the percentage of cases with adequate HPV DNA for molecular testing in each of the categories was compared. When available, p16 immunohistochemistry performed on the cases was compared with HPV status by molecular testing.Results:A total of 70 cases from 67 patients were included in the study. Adequate DNA for molecular HPV testing was obtained from samples of 47 cases (67%) while samples from 23 cases (33%) were inadequate for molecular testing. Of the adequate samples, 36 (77%) were positive and 11 (23%) were negative for high-risk HPV. Adequate DNA for testing was obtained in 22 out of 33 cases showing no necrosis (67%), 10 out of 16 cases showing partial necrosis (63%) and in 13 out of 17 cases showing extensive necrosis (76%).Conclusion:Our study found that HPV molecular testing is not influenced by percent tumor necrosis or method by which FNA was performed. We believe that a portion of the FNA specimen obtained from head and neck lesions diagnosed as SCC during the rapid on-site evaluation should be sent for HPV DNA testing, independent of the amount of tumor necrosis, thus guaranteeing availability of specimen for HPV testing.

show abstract

Section: Discussionmentioning

confidence: 99%

Adequacy of fine-needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Importantly, diagnostic tissues may be very scant in patients with small primary tumors, making it difficult to perform further analyses such as HPV testing. In addition, there is a growing interest in the use of cytology for the evaluation of HN lesions . In fact, although histology represents the gold standard in HN pathology, cytologic sampling and liquid‐based cytology might represent valuable tools for an initial assessment of the lesions, allowing for the simultaneous evaluation of morphology and HPV infection.…”

Section: Introductionmentioning

confidence: 99%

Cytology and human papillomavirus testing on cytobrushing samples from patients with head and neck squamous cell carcinoma

Donà

Giuliani

Vocaturo³

et al. 2014

Cancer

View full text Add to dashboard Cite

BACKGROUND:The increasing incidence of human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) highlights the need for simple and effective tools to evaluate head and neck lesions and their HPV status. The main objective of the current study was to investigate the association between abnormal cytology and HPV infection, assessed on cytobrushing samples, and histologically confirmed HNSCC. Second, the authors attempted to investigate whether HPV status on cytobrushing samples reflected that of the tumoral tissue. METHODS: A total of 164 samples from HNSCC, nonmalignant lesions, or healthy mucosae of the oral cavity and oropharynx were collected by cytobrushing in PreservCyt solution and evaluated by liquid-based cytology and Linear Array HPV genotyping test. All the findings from the cytologic samples were compared with those from the corresponding histologic samples. RESULTS: Patients with abnormal cytology had a significantly higher risk of having an HNSCC (odds ratio [OR], 9.18; 95% confidence inteval [95% CI], 3.27-26.49). The association was stronger for oral cancer (OR, 10.86; 95% CI, 2.51-51.06) than oropharyngeal cancer (OR, 8.45; 95% CI,. HPV positivity in the oropharyngeal cytobrushing was associated with a nearly 5-fold higher risk of having abnormal cytology (OR, 4.57; 95% CI, 1.57-13.57) as well as histologically proven oropharyngeal cancer (OR, 5.09; 95% CI, 1.09-31.61). Comparing the HPV status on cytologic and corresponding histologic samples from patients with HNSCC, we found that 90.4% of the cases were concordant (kappa, 0.796). CONCLUSIONS: Abnormal brushing cytology is strongly associated with a diagnosis of HNSCC, whereas HPV positivity on cytobrushing samples is only associated with oropharyngeal cancer. HPV testing on cytobrushing samples represents a valid option for the assessment of HPV infection in patients with oropharyngeal cancer. Cancer 2014;120:3477-84. V C 2014 American Cancer Society.KEYWORDS: cytology, human papillomavirus, head and neck, squamous cell carcinoma. INTRODUCTIONThe incidence of human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) has been significantly increasing over the last few years, as demonstrated by a growing number of studies conducted in Europe and North America. 1,2 HPV, particularly the HPV type 16, has been found to be etiologically associated especially with SCC of the oropharynx. 3,4 Notably, HPV-positive cancers differ from the HPV-negative ones with regard to response to treatment and survival, with HPV infection being a favorable prognostic marker. 5-7 Therefore, HPV testing is acquiring a growing significance for patients with HNSCC, particularly those with oropharyngeal SCC, and there is an increasing demand for simple, rapid, and effective methods for sample collection and the evaluation of HPV infection. Importantly, diagnostic tissues may be very scant in patients with small primary tumors, making it difficult to perform further analyses such as HPV testing. In addition, there is a growing ...

show abstract

“…However, the lack of access, the significant cost, and the longer turnaround time make the clinical use of these methods less attractive. HPV ISH has been studied in both surgical and cytologic specimens . Although p16 immunostaining is an excellent surrogate marker for an HR‐HPV infection, this test method lacks specificity beyond the oropharynx.…”

Section: Discussionmentioning

confidence: 99%

“…PCR analysis has the advantage of high sensitivity, but it may detect passenger DNA rather than specifically targeting driver or transcriptionally active infections, and it is more technically challenging. ISH has greater specificity with slightly lower sensitivity, and it provides the ability to visualize the presence of a signal in the targeted malignant cells …”

Section: Introductionmentioning

confidence: 99%

HPV testing through p16 immunocytochemistry in neck‐mass FNA and its correlation with tissue samples

Yang

Gomez‐Fernandez

Gonzalez

et al. 2019

Cancer Cytopathology

View full text Add to dashboard Cite

Background Fine‐needle aspiration (FNA) of a neck mass is frequently the initial diagnostic procedure for patients with human papillomavirus–positive head and neck squamous cell carcinoma. By performing a p16 immunocytochemistry (ICC) stain on FNA material, the pathologist can help to direct the treating physician's search for the primary site and to select the proper management for the patient. There is currently no established threshold for the evaluation of p16 ICC in cytology samples. This study was aimed at establishing an optimal threshold for p16 ICC interpretation in cytology samples. Methods The pathology databases were searched for all neck‐mass FNAs diagnosed as squamous cell carcinoma from January 2010 to March 2019. p16 ICC was performed on cytology smears, and the percentage and intensity of p16‐positive cells were assessed. Receiver operating characteristic (ROC) curves were plotted to determine the best cutoff threshold for p16 positivity on cytology smears. Results p16 ICC was performed on 50 cytology smears. An analysis of 8 different thresholds (combinations of the percentage and intensity of the p16 stain) using ROC curves demonstrated the best threshold to be 50% p16 staining with a sensitivity of 74% and a specificity of 100%. Applying the threshold used for surgical specimens (70%) to cytology samples resulted in a low sensitivity (45%). Conclusions p16 ICC on cytology smears shows diminished staining in comparison with surgical samples. Using 50% staining as the cutoff to consider positivity for p16 in cytology smears is proposed to decrease false‐negative results while maintaining specificity.

show abstract

Role of Cytology in the Diagnosis and Management of HPV-Associated Head and Neck Carcinoma

Cited by 55 publications

References 151 publications

Adequacy of fine-needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma

Adequacy of fine-needle aspiration specimens for human papillomavirus infection molecular testing in head and neck squamous cell carcinoma

Cytology and human papillomavirus testing on cytobrushing samples from patients with head and neck squamous cell carcinoma

HPV testing through p16 immunocytochemistry in neck‐mass FNA and its correlation with tissue samples

Contact Info

Product

Resources

About