The College of American Pathologists (CAP) updated its testing guideline to capture new research and emerging technologies to improve the diagnostic accuracy of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas, according to a guideline update published by Lewis et al in the Archives of Pathology & Laboratory Medicine.
Background
Oropharyngeal squamous cell carcinomas associated with HPV have continued to increase in recent years. Globally, an estimated 30% of oropharyngeal squamous cell carcinomas are linked to HPV. In the United States and parts of Europe, this figure is higher, ranging from 58% to 71% of oropharyngeal squamous cell carcinomas.
“Most HPV-associated [squamous cell] carcinomas are first detected by fine-needle aspiration,” explained William C. Faquin, MD, PhD, FCAP, Co-Chair of the updated guideline. “This guideline significantly clarifies the best approach for [high-risk] HPV testing of [fine-needle aspiration] samples, resulting in a more accurate and early diagnosis [that] translates into improved patient care,” he added.
Overview of Guideline Update
The CAP’s updated evidence-based practice guideline—developed by an expert interdisciplinary panel of pathologists, surgeons, radiation oncologists, and medical oncologists—was designed to enhance and standardize HPV testing practices across pathology practice settings.
Among the guideline updates were seven strong recommendations, four recommendations, and five good practice statements, including the following:
- Expanded testing applications: broader use of HPV-specific testing such as cytology specimens
- Enhanced guidance for oropharyngeal squamous cell carcinomas: recommendations for HPV-specific testing when p16 immunohistochemistry alone is insufficient
- Routine testing for specific cancers: sinonasal squamous cell carcinoma, cervical metastatic squamous cell carcinoma of unknown primary origin, and cervical fine-needle aspiration specimens
- Optimal testing methods: identification of highest-performing HPV-specific tests with comprehensive HPV type coverage.
Conclusions
The update synthesized research published since the original guideline’s release in 2018 and provided actionable guidance for HPV testing in various head and neck carcinomas. It also highlighted cell-free HPV testing as a potential emerging technology for future diagnostic applications.
“Although the sinonasal tract is not a common site for primary squamous cell carcinoma overall, the new recommendation to test patients with squamous cell carcinoma arising here should allow for the development of more precision treatment for these patients,” underscored James S. Lewis, Jr, MD, FACP, Co-Chair of the updated guideline.
The CAP plans to reassess the guideline every 5 years or sooner, as warranted by advancements in research or clinical practice.
Disclosure: For full disclosures of the guideline authors, visit meridian.allenpress.com.
