Northfield, Ill. (March 24, 2025) — As oropharyngeal squamous cell carcinomas (SCC) associated with human papillomavirus (HPV) have continued to increase in recent years, the College of American Pathologists (CAP) updated its testing guideline to capture new research and emerging technologies to improve diagnostic accuracy.
The CAP’s updated evidence-based practice guideline, “Human Papillomavirus (HPV) Testing in Head and Neck Carcinomas,” was developed by an expert interdisciplinary panel of pathologists, surgeons, radiation oncologists, and medical oncologists, and was published today in Archives of Pathology & Laboratory Medicine. The updated 2018 guideline aims to enhance and standardize HPV testing practices across pathology practice settings.
Globally, an estimated 30% of oropharyngeal SCCs are HPV-associated. In the United States and parts of Europe, this figure is significantly higher, ranging from 58% to 71% of oropharyngeal SCC.
Key Updates in the Guideline
“Most HPV-associated head and neck carcinomas are first detected by fine-needle aspiration,” said guideline co-chair William C. Faquin, MD, PhD, FCAP. “This guideline significantly clarifies the best approach for HR-HPV testing of FNA samples, resulting in a more accurate and early diagnosis which translates into improved patient care.”
Updates to the guideline include seven strong recommendations, four recommendations, and five good practice statements. Notable updates include:
- Expanded Testing Applications: Broader use of HPV-specific testing, including cytology specimens.
Enhanced Guidance for OPSCC: Recommendations for HPV-specific testing when p16 immunohistochemistry alone is insufficient.
- Routine Testing for Specific Cancers:
- Sinonasal squamous cell carcinoma.
- Cervical metastatic SCC of unknown primary origin.
- Cervical fine needle aspiration specimens.
- Optimal Testing Methods: Identification of highest-performing HPV-specific tests with comprehensive HPV type coverage.
“Although the sinonasal tract is not a common site for primary squamous cell carcinoma overall, the new recommendation to test patients with squamous cell carcinoma arising here should allow for the development of more precision treatment for these patients,” shared guideline co-chair James S. Lewis Jr., MD, FCAP.
This update synthesizes research published since the original guideline’s release and provides actionable guidance for HPV testing in various head and neck carcinomas. It also highlights cell-free HPV testing as a promising emerging technology for future diagnostic applications.
The CAP will reassess the guideline every five years or sooner, as warranted by advancements in research or clinical practice.
For tools, resources, and further details, visit the guideline webpage on cap.org.
About the College of American Pathologists
As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, visit the CAP Newsroom, CAP.org and yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care.
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