Human Papillomavirus Testing in Head and Neck Carcinomas Guideline From the College of American Pathologists
Human Papillomavirus Testing in Head and Neck Carcinomas Guideline From the College of American Pathologists
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DOI：
10.5858/arpa.2017-0286-cp
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发表时间：
2018-05-01
影响因子：
4.6
通讯作者：
Faquin, William C.
中科院分区：
文献类型：
--
作者：
Lewis, James S., Jr.;Beadle, Beth;Faquin, William C.
背景-人类乳头瘤病毒(HPV)是口咽鳞状细胞癌的主要原因，HPV(和/或替代标志物p16)状态已成为显著影响临床治疗的预后标志物。关于何时检测口咽鳞状细胞癌的HPV/p16或选择哪种检测方法，目前还没有达成共识。目的：为头颈癌中HPV和替代标志物测试的测试、应用、解释和报告制定循证建议。设计-美国病理学家学会召集头颈部和分子病理学以及外科、内科和放射肿瘤学的专家小组制定建议。对文献进行了系统的回顾，以解决6个关键问题。结果：主要建议包括(1)检测新诊断的口咽鳞状细胞癌患者的高危HPV，无论是来自原发肿瘤还是来自颈部淋巴结转移，使用p16免疫组织化学方法，以70%的核浆染色为截止点，以及(2)不常规检测非鳞状口咽癌或非口咽癌的HPV。病理学家将报告肿瘤为HPV阳性或p16阳性。结论：根据系统回顾和专家小组的共识，建议对所有新发口咽鳞状细胞癌患者进行高危HPV检测，但不建议对其他头颈部癌患者进行常规检测。
Context.-Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose.Objective.-To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas.Design.-The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus.Results.-The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens.Conclusions.-Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.