ABSTRACT
OBJECTIVE: To determine whether the human papillomavirus (HPV) status of head and neck squamous cell carcinomas (HNSCCs) can be reliably predicted based on sociodemographic and disease characteristics alone. DESIGN A retrospective medical chart review of clinical and pathologic features. SETTING: Tertiary academic medical center. PATIENTS: We studied patients treated for HNSCC who were tested for markers of HPV or had tissue available for testing between 2006 and 2010. MAIN OUTCOME MEASURES: Four otolaryngology-head and neck surgery trainees were given the database of patient clinical and pathologic features and asked to predict the HPV status for each patient. The trainees' responses were scored for accuracy, positive and negative predictive value, and interrater agreement. Multiple linear regression analyses were performed to determine predictors of HPV positivity. RESULTS: A total of 174 patients meeting inclusion criteria were identified, 95 of whom were determined to have HPV-positive tumor tissue. Residents were able to accurately predict HPV status in 110 to 125 patients (63%-72%), with positive predictive values of 76% to 84% and negative predictive values of 61% to 69%. The only variables significantly related to HPV status were male sex (P = .01) and oropharyngeal subsite (P = .02). Only 4 patients had a "typical" HPV-positive profile. CONCLUSIONS: Knowledge of cancer stage, primary site, basaloid features, tumor differentiation, and presence of cystic neck disease and patient age, race, and smoking status did not allow accurate predictions of HPV status in many patients. Clinical testing of tumor tissue remains essential for a diagnosis of HPV-positive disease.
Subject(s)
Carcinoma, Squamous Cell/virology , Head and Neck Neoplasms/virology , Papillomaviridae/isolation & purification , Carcinoma, Squamous Cell/surgery , Female , Head and Neck Neoplasms/surgery , Humans , Immunohistochemistry , In Situ Hybridization , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , Socioeconomic FactorsABSTRACT
OPINION STATEMENT: Well differentiated thyroid carcinoma (WDTC) is a relatively common malignancy accounting for an estimated 37,000 thousand cases in the United States in 2009 [1]. WDTC also has a generally high 5 year survival rate that correlates with age. Papillary thyroid carcinoma (PTC) greater than 1 cm is best managed by total thyroidectomy. Thyroid lobectomy and isthmusectomy may be adequate for unifocal PTC less than 1 cm in patients without negative prognostic factors. Central compartment and possible lateral neck dissections should be performed when nodal metastases are present in the respective nodal basins. Post-operatively, radioactive iodine ablation with (131)I followed by thyroid stimulating hormone (TSH) suppression is indicated in certain patients to improve locoregional control and reduce recurrence.
