From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Ferguson).
The Department of Pathology, Microbiology, and Immunology (Ferguson, Mehrad, Ely, Lewis Jr), Vanderbilt University Medical Center, Nashville, Tennessee.
Arch Pathol Lab Med. 2021 Sep 1;145(9):1123-1131. doi: 10.5858/arpa.2020-0220-OA.
CONTEXT.—: Given the growing clinical significance of human papillomavirus status in oropharyngeal squamous cell carcinoma, the College of American Pathologists established a set of evidence-based recommendations for high-risk human papillomavirus testing for publication in a guideline.
OBJECTIVE.—: To evaluate the impact of the recommendations on human papillomavirus ancillary test ordering habits by comparing compliance before and after the guideline was published.
DESIGN.—: We retrospectively reviewed head and neck squamous cell carcinoma biopsy or resection specimens from outside institutions during a 2.5-year period around guideline publication to determine whether human papillomavirus testing was performed in accordance with the guideline.
RESULTS.—: Human papillomavirus testing deviated from the guideline in 45 of 107 cases (42.1%) before and 93 of 258 cases (36.0%) after its publication (P = .29). This included 6 of 26 cases of oropharyngeal squamous cell carcinoma (23.1%) before and 5 of 55 cases (9.1%) after (P = .16), with 5 of 5 (100.0%) after due to not performing p16 immunohistochemistry. This also included 30 of 68 cases of nonoropharyngeal carcinoma (44.1%) before and 69 of 163 (42.3%) after the guideline was published (P = .88), with 29 of 30 (96.7%) before and 67 of 69 (97.1%) after due to unnecessary use of p16 immunohistochemistry. Nodal metastasis testing deviated in 9 of 13 cases (69.2%) before and 19 of 40 cases (47.5%) after (P = .21) with marked variability in testing, including 3 of 9 (33.3%) before and 8 of 19 (42.1%) after, for not confirming certain p16 immunohistochemistry-positive tumors with human papillomavirus-specific testing.
CONCLUSIONS.—: Pathologists continue to deviate from the testing guideline significantly in everyday practice. Further education and discussion about the appropriate handling of head and neck cancer specimens may be needed.
鉴于人乳头瘤病毒（HPV）在口咽鳞状细胞癌中的临床意义日益重要，美国病理学家学院为 HPV 高危检测制定了一套循证推荐意见，并将其发表为指南。
通过比较指南发布前后辅助 HPV 检测的订购习惯，评估该推荐意见对 HPV 辅助检测的影响。
我们回顾性分析了指南发布前后 2.5 年期间外院送检的头颈部鳞状细胞癌活检或切除术标本，以确定 HPV 检测是否符合该指南。
在指南发布前的 107 例标本中有 45 例（42.1%），指南发布后的 258 例标本中有 93 例（36.0%）不符合该指南（P =.29）。其中，26 例口咽鳞状细胞癌中有 6 例（23.1%），55 例中有 5 例（9.1%）（P =.16），5 例均为未行 p16 免疫组化检测。68 例非口咽癌中有 30 例（44.1%），163 例中有 69 例（42.3%）不符合（P =.88），29 例是因为未行 p16 免疫组化检测，67 例是因为行不必要的 p16 免疫组化检测。在淋巴结转移检测中，13 例中有 9 例（69.2%），40 例中有 19 例（47.5%）不符合（P =.21），且检测存在明显差异，9 例中有 3 例（33.3%），19 例中有 8 例（42.1%）未对特定 p16 免疫组化阳性肿瘤进行 HPV 检测。
病理医生在日常实践中仍严重偏离检测指南。可能需要进一步的教育和讨论，以规范头颈部癌标本的处理。
