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Transcervical sonography and human papillomavirus 16 E6 antibodies are sensitive for the detection of oropharyngeal cancer
Author(s) -
Lang Kuhs Krystle A.,
Wood C. Burton,
Wiggleton Jamie,
Aulino Joseph M.,
Latimer Brian,
Smith Derek K.,
Bender Noemi,
Rohde Sarah,
Mannion Kyle,
Kim Young,
Sinard Robert,
Langerman Alexander,
Fleischer Arthur,
Fakhry Carole,
Waterboer Tim,
Netterville James L.
Publication year - 2020
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32799
Subject(s) - medicine , gold standard (test) , confidence interval , radiology , serology , cancer , positron emission tomography , human papillomavirus , nuclear medicine , antibody , immunology
Background Human papillomavirus 16 (HPV‐16) E6 seropositivity is a promising early marker of human papillomavirus–driven oropharyngeal cancer (HPV‐OPC), yet more sensitive imaging modalities are needed before screening is considered. The objective of this study was to determine the sensitivity of transcervical sonography (TCS) for detecting clinically apparent HPV‐OPC in comparison with computed tomography (CT) and positron emission tomography (PET)/CT. Methods Fifty‐one patients with known or suspected HPV‐OPC without prior treatment underwent oropharyngeal TCS and blood collection (for HPV multiplex serology testing). Eight standard sonographic images were collected; primary‐site tumors were measured in 3 dimensions if identified. Each patient underwent a full diagnostic workup as part of standard clinical care. The pathologic details, HPV status, final staging, and imaging findings were abstracted from the medical record. The sensitivity of each imaging modality was compared with the final clinical diagnosis (the gold standard). Results Twenty‐four base of tongue cancers (47%), 22 tonsillar cancers (43%), and 2 unknown primary cancers (4%) were diagnosed; 3 patients (6%) had no tumors. All p16‐tested patients were positive (n = 47). Primary‐site tumors were correctly identified in 90.2% (95% confidence interval [CI], 78.6%‐96.7%) with TCS, in 69.4% (95% CI, 54.6%‐81.7%) with CT, and in 83.3% (95% CI, 68.6%‐93.0%) with PET/CT. TCS identified tumors in 10 of 14 cases missed by CT and recognized the absence of tumors in 3 cases for which CT or PET/CT was falsely positive. The smallest sonographically identified primary‐site tumor was 0.5 cm in its greatest dimension; the average size was 2.3 cm. Among p16‐positive patients, 76.1% (95% CI, 61.2%‐87.4%) were seropositive for HPV‐16 E6. Conclusions TCS and HPV‐16 E6 antibodies are sensitive for the diagnosis of HPV‐OPC.