The College of American Pathologists created a guideline for the testing, application, interpretation, and reporting of human papillomavirus (HPV) in head and neck carcinomas. An ASCO Expert Panel recently reviewed the guideline and published their critique in the Journal of Clinical Oncology.1

“The ASCO Expert Panel determined that the recommendations from the HPV Testing in Head and Neck Carcinomas guideline, published in 2018, are clear, thorough, and based upon the most relevant scientific evidence,” the authors wrote.

The ASCO Expert Panel endorsed the guideline and made recommendations and provided qualifying statements to fine-tune the language and content of the College of American Pathologists guideline.

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The Panel recommends establishing HPV tumor status for patients with newly diagnosed oropharyngeal squamous cell carcinomas. Also HPV tumor testing can be done by “surrogate marker p16 immunohistochemistry either on the primary tumor or from cervical nodal metastases only if an oropharyngeal primary tumor is present,” the Panel wrote. The threshold for p16 immunohistochemistry positivity is “at least 70% nuclear and cytoplasmic expression with at least moderate to strong intensity.”  Furthermore, the pathologist and/or treating clinician can perform additional confirmatory testing at their discretion, suggested the Panel.

The Panel also recommends that pathologists do not routinely identify HPV tumor status in patients with nonsquamous carcinomas of the oropharynx or non–oropharyngeal squamous cell carcinomas of the head and neck. HPV tumor status testing may be warranted, the Panel advises, when histologic type is uncertain or it’s unclear whether a poorly differentiated oropharyngeal tumor is nonsquamous.


  1. Fakhry C, Lacchetti C, Rooper LM, et al. Human papillomavirus testing in head and neck carcinomas: ASCO Clinical Practice Guideline endorsement of the College of American Pathologists guideline. J Clin Oncol. 2018;36:3152-3161. doi: 10.1200/JCO.18.00684