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Head and Neck Pathology

, Volume 6, Supplement 1, pp 83–90 | Cite as

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

  • Max RobinsonEmail author
  • Andrew Schache
  • Philip Sloan
  • Selvam Thavaraj
Invited Review

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.

Keywords

Oropharynx Squamous cell carcinoma Human papillomavirus Molecular diagnosis 

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Max Robinson
    • 1
    • 2
    Email author
  • Andrew Schache
    • 3
    • 4
  • Philip Sloan
    • 1
    • 2
  • Selvam Thavaraj
    • 5
  1. 1.Centre for Oral Health Research, School of Dental SciencesNewcastle UniversityNewcastle upon TyneUK
  2. 2.Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
  3. 3.Department of Molecular and Clinical Cancer Medicine, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
  4. 4.Regional Maxillofacial UnitUniversity Hospital AintreeLiverpoolUK
  5. 5.Oral PathologyKing’s College London Dental InstituteLondonUK

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