Human papillomavirus detection in fine needle aspiration cytology of lymph node metastasis of head and neck squamous cell cancer

- hrHPV can be detected in FNAC of cervical lymph node metastases.
- hrHPV in lymph node metastases can identify head and neck squamous cell cancers.
- The hrHPV PCR showed a sensitivity of 96% and a specificity of 100%.
- hrHPV presence can manage decisions on the primary treatment modality.

BackgroundCurrently, testing on HPV in oropharyngeal squamous cell carcinoma (OPSCC) is performed on histological material. However, in a certain percentage of the cases who present with lymph node metastases no primary tumor can be identified and only fine needle aspiration cytology (FNAC) is available for analysis.ObjectivesPurpose of this study was to assess HPV status on FNAC and to validate it using histological material of the same patients.Study designPatients with cervical metastasis from OPSCC or cancer of an unknown primary tumor (CUP), diagnosed between 2007 and 2012 were included. In 6 of the 47 patients, no primary tumor could be identified. HPV detection and genotyping was performed in both FNAC slides scrapings and formalin fixed paraffin embedded (FFPE) histological material from the same patients, using the HPV SPF10-LiPA25 assay. HPV PCR analysis on FFPE material was considered the reference standard for HPV status of each case.ResultsCompared with HPV negative cases (n = 22), significantly more HPV positive cases (n = 25) presented initially with cervical metastasis (27% vs 56% respectively; p = 0·047). The HPV PCR assay on FNAC material showed a high sensitivity (96%; 95% CI 86.6-97.4) and specificity (100%; 95% CI 85.1-96.7) using the reference standard of HPV PCR analysis on FFPE material of the same patients.ConclusionIn this study, testing on HPV in FNAC of cervical lymph node metastases of SCC is validated. It provides a valuable alternative for testing of HPV on histological material from patients with oropharyngeal squamous cell carcinoma or cancer of an unknown primary tumor.