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Diagnosis of HPV-driven head and neck cancer with a single test in routine clinical practice.

日常临床实践中单项检测对人乳头瘤病毒感染导致头颈部肿瘤的诊断

Mirghani H,Casiraghi O,Amen F,He M,Ma XJ,Saulnier P,Lacroix L,Drusch F,Ben Lakdhar A,Saint Guily JL,Badoual C,Scoazec JY,Vielh P

Abstract

Accurate screening of HPV-driven head and neck squamous cell carcinoma is a critical issue. Although there are commercial direct and indirect assays for HPV-related head and neck squamous cell carcinoma, none are ideal. Recently, a novel RNA in situ hybridization test (the RNAscope HPV-test) has been developed for the detection of high-risk HPV E6/E7 mRNA in formalin-fixed paraffin-embedded tissue. However, validation of this assay against the 'gold standard' (identification of high-risk HPV E6/E7 mRNA in fresh-frozen tissue by quantitative real-time (qRT)-PCR) has only been reported by one team. Formalin-fixed paraffin-embedded samples from 50 patients with tonsil or tongue base carcinoma were tested using the RNAscope HPV-test, p16 immunohistochemistry, and chromogenic in situ hybridization for high-risk HPV-DNA. The results were compared with those of qRT-PCR on matched fresh-frozen samples. Compared with the reference test, the sensitivity, specificity, positive, and negative predictive values of the RNAscope HPV-test and of p16 immunohistochemistry were 93%, 94%, 96%, 88% and 96%, 93%, 96%, and 93%, respectively. Five cases were discrepant between the RNAscope HPV-test and p16-immunohistochemisrty. The RNAscope HPV-test demonstrated excellent analytical performance against the 'gold standard' and is easier to interpret than chromogenic in situ hybridization. p16-immunohistochemistry also performed very well, however its main weakness is that it is an indirect marker of the presence of HPV. These data suggest that the RNAscope HPV-test is a promising test that could be developed as a clinical standard for the precise identification of HPV-driven oropharyngeal squamous cell carcinoma.

摘要

如何准确筛选人乳头瘤病毒(HPV)感染相关的头颈部鳞状细胞癌是个有争议的话题。尽管有不少商业化方案可以直接或间接检测HPV相关的头颈部肿瘤,但是都不太理想。最近,我们使用RNAscope HPV技术检测石蜡包埋组织中的高危型HPV E6/E7mRNA。然而,只有一个单位报到过这项技术的应用(通过实时定量PCR检测新鲜冰冻组织中高危型HPV E6/E7mRNA作为标准)。使用RNAscope HPV检测、P16免疫组化检测和显色原位杂交技术检测50例扁桃体或舌根癌患者石蜡包埋标本中的高危型HPV-DNA,结果与新鲜冰冻标本的实时定量PCR进行比较。RNAscope HPV检测和P16免疫组化检查的敏感性、特异性、阳性率与阴性率分别是93%、94%、96%、88%和96%、93%、96%、93%。有五例这两项检查有差异。RNAscope HPV检测比实时定量PCR具有更好的分析性能,比原位杂交更容易解释。P16免疫组化检查也是一项不错的指标,而最主要的缺点是它不能直接证明HPV存在。数据表明RNAscope HPV检测很有发展前景,它可以作为HPV感染相关口咽部鳞癌的一种临床诊断标准。

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