Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

Patrick O McGarey Jr; Osama Hamdi; Lane Donaldson; Kevin Zhan; Edwin F Crandley; David D Wilson; Austin J Sim; Paul W Read; Jonathan C Garneau; Katherine L Fedder; David C Shonka Jr; Mark J Jameson

doi:10.1055/s-0043-1767795

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

Int Arch Otorhinolaryngol. 2024 Feb 5;28(1):e42-e49. doi: 10.1055/s-0043-1767795. eCollection 2024 Jan.

Affiliations

¹ Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States.
² Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States.

Abstract

Introduction Human papillomavirus-related (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation. Objective The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis. Methods Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002-2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis. Results p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-; p < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-; p < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed; p = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-; p = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-, p = 0.03). Conclusions Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment.

Keywords: HPV; head and neck cancer; human papillomavirus viruses; oropharyngeal squamous cell carcinoma.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ( https://creativecommons.org/licenses/by/4.0/ ).