CAP Updates Guideline to Improve HPV Testing in Head and Neck Cancers

As rates of oropharyngeal squamous cell carcinomas (SCC) associated with human papillomavirus (HPV) continue to rise, the College of American Pathologists (CAP) has released an updated evidence-based guideline to enhance HPV testing in head and neck carcinomas. The guideline, "Human Papillomavirus (HPV) Testing in Head and Neck Carcinomas," published in Archives of Pathology & Laboratory Medicine, reflects the latest research and technological advancements to improve diagnostic accuracy and patient outcomes.

HPV-associated oropharyngeal SCC represents a significant global health challenge. While approximately 30% of oropharyngeal SCCs worldwide are linked to HPV, this percentage rises to 58%–71% in the United States and parts of Europe. Given these increasing rates, refining HPV testing practices is crucial for early detection and effective treatment.

Most HPV-associated head and neck carcinomas are first detected by fine-needle aspiration (FNA). This guideline significantly clarifies the best approach for high-risk HPV testing of FNA samples, resulting in a more accurate and early diagnosis, which translates into improved patient care.

The updated guideline, which builds upon the CAP’s 2018 recommendations, includes seven strong recommendations, four recommendations, and five good practice statements. These updates aim to standardize HPV testing across pathology practice settings and improve diagnostic precision.

Notable guideline updates include:

• Expanded Testing Applications: Increased use of HPV-specific testing, including cytology specimens.
• Enhanced Guidance for Oropharyngeal SCC (OPSCC): Recommendations for HPV-specific testing in scenarios where p16 immunohistochemistry alone is insufficient.
• Routine Testing for Specific Cancers:
  • Sinonasal squamous cell carcinoma.
  • Cervical metastatic SCC of unknown primary origin.
  • Cervical fine-needle aspiration specimens.
• Optimal Testing Methods: Identification of the highest-performing HPV-specific tests with comprehensive HPV type coverage.

Although the sinonasal tract is not a common site for primary squamous cell carcinoma overall, the new recommendation to test patients with SCC in this region should allow for the development of more precision treatment for these patients.

The CAP guideline also highlights cell-free HPV testing as an emerging technology with potential applications in diagnosing head and neck carcinomas. As research advances, new testing methods could further refine diagnostic capabilities and treatment strategies.

The updated guideline for HPV testing in head and neck carcinomas will be reviewed every five years or sooner if warranted by new scientific developments or changes in clinical practice.

For additional resources, tools, and in-depth information on HPV testing recommendations, visit Human Papillomavirus Testing in Head and Neck Carcinomas on cap.org. 
 

Dr. Faquin is Professor of Pathology at Harvard Medical School, Chief of Otolaryngologic Pathology at the Massachusetts Eye and Ear and a subspecialist in Head and Neck Pathology & Cytopathology at the Massachusetts General Hospital in Boston.  He is the Editor-in-Chief for Cancer Cytopathology, co-author of the new ARP Fascicle for Upper Aerodigestive Tract Tumors, and co-chair of the College of American Pathologists evidence-based guideline panel for HPV testing in the head and neck. 

James (Jim) Lewis Jr. M.D. is a Senior Associate Consultant at Mayo Clinic Arizona, has 20+ years of experience as an academic head and neck pathologist, and is co-chair of the College of American Pathologists Expert Panel on HPV Testing in Head and Neck Carcinomas.  He received his medical school, residency, and fellowship training at Washington University in St. Louis and is board certified in anatomic and clinical pathology.