{'fraction_non_alphanumeric': 0.03093112244897959, 'fraction_numerical': 0.007334183673469388, 'mean_word_length': 5.236580516898608, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Human papillomavirus (HPV) assays for testing fine‐needle aspiration specimens in patients with head and neck squamous cell carcinoma

Human papillomavirus (HPV)-related oropharyngeal carcinoma is a distinct form of head and neck squamous cell carcinoma (HNSCC) at the morphologic, epidemiologic, and molecular levels. In contrast to nonHPV–related HNSCC, HPV-related oropharyngeal carcinoma has had a dramatic, increasing incidence in the United States over the past 3 decades. In many institutions, including ours, greater than 80% to 90% of oropharyngeal squamous cell carcinomas (SCCs), which occur primarily in the palatine tonsil and base of tongue, are associated with high risk-HPV (HR-HPV) types, predominantly HPV type 16 (HPV16). Cancer in these patients is driven by the production of the HPV E6 and E7 oncoproteins, which interfere with p53 and pRb tumor-suppressor pathways. A consequence of this includes the overexpression of p16, which, in selected clinical contexts, can be used as an immunohistochemical surrogate marker of HR-HPV infection. HPVrelated HNSCCs often are associated with an improved response to therapy; therefore, the diagnosis of HPVrelated HNSCC has potentially important therapeutic and prognostic implications. Because of the tendency of HPV-related HNSCC to metastasize to cervical lymph nodes, fine-needle aspiration (FNA) is frequently used for its initial evaluation and diagnosis. In this context, accurate and efficient testing methods for HR-HPV are needed for the evaluation of HNSCCs in cytologic preparations. The article by Guo et al in this issue of Cancer Cytopathology addresses the validity of using the Cervista HPV16/18 and Cervista HPV HR assays [Hologic, Inc., Marlborough, Mass], 2 of several US Food and Drug Administrationapproved methods for testing HPV in cervical cytology specimens, for the detection of HR-HPV in FNA specimens of HNSCC. The availability of valid methods, such as that described by Guo et al, for detecting HRHPV in FNA specimens of HNSCC is important for multiple reasons. First, as alluded to previously, the demonstration of HR-HPV in HNSCC has significant implications for patient prognosis, because many of these patients will have improved outcomes in terms of overall survival, progression-free survival, and disease-specific survival compared with patients who have non-HPV–related HNSCC. The typical patient with HPVrelated HNSCC is a middle-aged man, nonsmoker, and nondrinker with sexual risk factors for oral HPV infection, and low T and high N in the TNM staging system. That being said, a group of HR-HPV-related HNSCCs remains in which the prognosis appears to be further modified by other features, such as TP53 mutations and expression of Bcl-2. Biomarkers like these are currently the subject of much research, because they have the potential to influence the therapeutic approach in patients with HPV-related HNSCC. Although changes in the management of patients with HPV-related HNSCC, such as de-escalation therapies, are currently limited to clinical trials, in the very near future, the demonstration of HPV positivity is likely to