Accuracy of high-risk HPV DNA PCR, p16(INK4a) immunohistochemistry or the combination of both to diagnose HPV-driven oropharyngeal cancer
Cindy Simoens, Tarik Gheit, Ruediger Ridder, Ivana Gorbašlieva, Dana Holzinger, Eric Lucas, Susanne Rehm, Peter Vermeulen, Martin Lammens, Olivier M. Vanderveken, Rekha Vijay Kumar, Nitin Gangane, Alessandro Caniglia, Fausto Maffini, Maria Belén Lloveras Rubio, Devasena Anantharaman, Susanna Chiocca, Paul Brennan, Madhavan Radhakrishna Pillai, Rengaswamy Sankaranarayanan, Johannes Bogers, Michael Pawlita, Massimo Tommasino, Marc Arbyn, the HPV-AHEAD study group, Christine Carreira, Sandrine McKay‐Chopin, R. S. Jayshree, Kortikere S. Sabitha, Ashok M. Shenoy, Alfredo Zito, Fausto Chiesa, Marta Tagliabue, Mohssen Ansarin, Subha Sankaran, Christel Herold‐Mende, Gerhard Dyckhoff, George Mosialos, Heiner Boeing, Xavier Castellsagué, Silvia de Sanjosé, M. Mena, F. Xavier Bosch, Laia Alemany, Pulikottil Okkuru Esmy, M. Vijayakumar, Aruna Chiwate, Ranjit Thorat, Girish G. Hublikar, Shashikant S. Lakshetti, Bhagwan M. Nene, Amal Kataki, Ashok Kumar Das, Kunnambath Ramadas, Thara Somanathan
Abstract
BACKGROUND: The incidence of high-risk human papillomavirus (hrHPV)-driven head and neck squamous cell carcinoma, in particular oropharyngeal cancers (OPC), is increasing in high-resource countries. Patients with HPV-induced cancer respond better to treatment and consequently have lower case-fatality rates than patients with HPV-unrelated OPC. These considerations highlight the importance of reliable and accurate markers to diagnose truly HPV-induced OPC. METHODS: immunohistochemistry (IHC) (p16), and (c) the combination of both tests (considering joint DNA and p16 positivity as positivity criterion), was analysed in tissue samples from 99 Belgian OPC patients enrolled in the HPV-AHEAD study. Presence of HPV E6*I mRNA (mRNA) was considered as the reference, indicating HPV etiology. RESULTS: Ninety-nine OPC patients were included, for which the positivity rates were 36.4%, 34.0% and 28.9% for DNA, p16 and mRNA, respectively. Ninety-five OPC patients had valid test results for all three tests (DNA, p16 and mRNA). Using mRNA status as the reference, DNA testing showed 100% (28/28) sensitivity, and 92.5% (62/67) specificity for the detection of HPV-driven cancer. p16 was 96.4% (27/28) sensitive and equally specific (92.5%; 62/67). The sensitivity and specificity of combined p16 + DNA testing was 96.4% (27/28) and 97.0% (65/67), respectively. In this series, p16 alone and combined p16 + DNA missed 1 in 28 HPV driven cancers, but p16 alone misclassified 5 in 67 non-HPV driven as positive, whereas combined testing would misclassify only 2 in 67. CONCLUSIONS: IHC are highly sensitive but less specific than using combined testing to diagnose HPV-driven OPC patients. Disease prognostication can be encouraged based on this combined test result.