How Adequate Are Head and Neck Fine-Needle Aspiration Specimens for HPV Molecular Analysis? An Institutional Experience.
Megan O Nakashima, Debbie Nielsen, Vivianna M van Deerlin, Gregory S Weinstein, Kathleen T Montone, Virginia A LiVolsi, Zubair W Baloch. Hospital of the University of Pennsylvania, Philadelphia
Background: Human papilloma virus (HPV) testing on head and neck squamous cell carcinomas is being increasingly performed in this era of “personalized medicine”. At our institution HPV testing is often requested on fine needle aspiration (FNA) specimens, usually of metastatic lesions, either prior to treatment or after recurrent/metastatic disease. In this study we report our experience with HPV testing on FNA specimens with regards to adequacy of specimen for molecular analysis and if it is affected by method of acquisition (manual v. radiologic guidance, # of passes) and quality of specimen (presence or absence of tumor necrosis).
Design: We searched our institutional pathology files for FNA specimens on which HPV testing (Hologic) was performed. The following data points were recorded: patient demographics, site of lesion, method of FNA procedure, quality and adequacy of specimen for molecular analysis.
Results: A cohort of 42 specimens diagnosed as squamous cell carcinoma (SCC) on FNA were selected in 40 patients (29 men & 11 women, average age 61 yrs); 16 had a prior diagnosis of oropharyngeal (OP) SCC at time of FNA. Thirty-six (86%) specimens were obtained from lymph nodes (cervical-32, supraclavicular-1, submandibular-1, level 7-1, level 11-1) and 6 from other sites (parotid, soft palate lesion, jaw mass, tonsil, lung, chest wall). Of the 42 specimens, 27 were from patients with primary OP lesions, 9 had lesions in oral cavity or larynx and 6 in other sites (parotid, esophagus, lung, cervix, neck, scalp). Thirty-three (79%) FNA specimens were obtained manually and 9 (21%) with radiologic guidance (average # passes 2.2). On-site assessment was performed in 41 (98%) cases; 31 (76%) were diagnosed as SCC and 5 (12%) as atypical/suspicious. A final FNA diagnosis of SCC was rendered in all cases; 9 FNA specimens showed extensive (>80%) tumor necrosis. DNA was adequate for molecular analysis in 28 (67%) specimens (19 positive, 9 negative for high risk HPV) including 7 with extensive tumor necrosis. Results in 14 cases were inconclusive due to inadequate DNA. In addition, 24 of 33 (73%) specimens obtained manually had adequate DNA compared to 4 of 9 (44%) collected with radiologic guidance. Primary OP tumors were more likely to have adequate DNA than non-OP (78% v. 47%).
Conclusions: In our experience HPV testing can be successfully performed on FNA specimens. Neither lack of radiologic guidance for obtaining FNA specimens nor presence of extensive tumor necrosis appears to decrease the likelihood of obtaining adequate DNA for HPV analysis.
Category: Quality Assurance
Monday, February 28, 2011 1:00 PM
Poster Session II # 220, Monday Afternoon