ASCO Endorses CAP Guideline for Human Papillomavirus Testing in Head and Neck Cancer


The American Society of Clinical Oncology (ASCO) has endorsed the College of American Pathologists (CAP) evidence-based guideline on testing, application, interpretation, and reporting of human papillomavirus (HPV) and surrogate marker tests in head and neck carcinomas.

The CAP HPV Testing in Head and Neck Carcinomas 2018 guideline was reviewed by ASCO experts for clinical accuracy and by methodologists for developmental rigor. Once favorable review was determined, an ASCO expert panel was convened to review the guideline recommendations.


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As a result of the review, ASCO endorsed the guideline and added minor qualifying statements. ASCO determined that the recommendations in the guideline are clear, thorough, and based upon the most recent and relevant scientific evidence. The endorsement was published as a special article in the Journal of Clinical Oncology (online September 2018; doi:10.1200/JCO.18.00684).

The recommendations and qualifying statements are as follows:

  • HPV tumor status should be determined for newly diagnosed oropharyngeal squamous cell carcinomas.
  • HPV tumor status testing may be performed by surrogate marker p16 immunohistochemistry either on the primary tumor or from cervical nodal metastases only if an oropharyngeal primary tumor is present.
  • The threshold for positivity is at least 70% nuclear and cytoplasmic expression with at least moderate to strong intensity.
  • Additional confirmatory testing may be done at the discretion of the pathologist or treating clinician.
  • Pathologists should not routinely determine HPV tumor status in non-squamous carcinomas of the oropharynx or non-oropharyngeal squamous cell carcinomas of the head and neck.
  • When there is uncertainty of histologic type or whether a poorly differentiated oropharyngeal tumor is non-squamous, HPV tumor status testing may be warranted and at the discretion of the pathologist or treating clinician.

ASCO offers additional information, including a Data Supplement, Methodology Supplement, slide sets, and clinical tools as well as resources.—Zachary Bessette