Oral Pathology, Department of Clinical and Diagnostic Sciences, King's College London Dental Institute, London, UK.
J Clin Pathol. 2011 Apr;64(4):308-12. doi: 10.1136/jcp.2010.088450. Epub 2011 Feb 23.
Oncogenic human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) is a subtype of head-and-neck cancer with a distinct clinical and prognostic profile. While there are calls to undertake HPV testing for oropharyngeal SCCs within the diagnostic setting and for clinical trials, there are currently no internationally accepted standards.
142 tonsil SCCs were tested using p16 immunohistochemistry (IHC), high-risk HPV DNA in situ hybridisation (ISH) and HPV DNA polymerase chain reaction (PCR; GP5+/6+ primers).
There were high levels of agreement between pathologists for p16 IHC and HPV ISH scoring; however, around 10% of HPV ISH cases showed some interobserver discrepancy that was resolved by slide review. The combination of p16 IHC and HPV ISH classified 53% of the samples as HPV-positive, whereas the combination of p16 IHC and HPV PCR classified 61% of the samples as HPV-positive. By employing a three-tiered, staged algorithm (p16 IHC/HPV ISH/HPV PCR), the authors were able to classify 98% of the cases as either HPV-positive (p16 IHC+/HPV DNA+; 62%) or HPV-negative (p16 IHC-/HPV DNA-; 35%).
The current study suggests that using a combination of p16 IHC/HPV ISH/HPV PCR, in a three-tiered, staged algorithm, in conjunction with consensus reporting of HPV ISH, leads to less equivocal molecular classification. In order to ensure consistent reporting of this emerging disease, it is increasingly important for the head-and-neck oncology community to define the minimum requirements for assigning a diagnosis of 'HPV-related' oropharyngeal SCC in order to inform prognosis and for stratification in clinical trials.
致癌性人乳头瘤病毒（HPV）相关的口咽鳞状细胞癌（SCC）是头颈部癌症的一种亚型，具有独特的临床和预后特征。虽然人们呼吁在诊断环境中以及临床试验中对头颈 SCC 进行 HPV 检测，但目前尚无国际公认的标准。
使用 p16 免疫组化（IHC）、高危型 HPV 原位杂交（ISH）和 HPV 聚合酶链反应（PCR；GP5+/6+ 引物）对 142 例扁桃体 SCC 进行了检测。
病理学家在 p16 IHC 和 HPV ISH 评分方面具有高度一致性；然而，大约 10%的 HPV ISH 病例存在一些观察者间差异，通过幻灯片审查得到解决。p16 IHC 和 HPV ISH 的组合将 53%的样本归类为 HPV 阳性，而 p16 IHC 和 HPV PCR 的组合将 61%的样本归类为 HPV 阳性。通过采用三阶梯、分阶段算法（p16 IHC/HPV ISH/HPV PCR），作者能够将 98%的病例归类为 HPV 阳性（p16 IHC+/HPV DNA+；62%）或 HPV 阴性（p16 IHC-/HPV DNA-；35%）。
本研究表明，使用 p16 IHC/HPV ISH/HPV PCR 联合共识报告 HPV ISH 的三阶梯、分阶段算法，可进行更明确的分子分类。为了确保对这种新兴疾病的一致报告，头颈部肿瘤学界越来越有必要定义诊断“HPV 相关”口咽 SCC 的最低要求，以告知预后并进行临床试验分层。
