Transcervical sonography and human papillomavirus 16 E6 antibodies are sensitive for the detection of oropharyngeal cancer

Krystle A. Lang Kuhs, C. Burton Wood, Jamie Wiggleton, Joseph M. Aulino, Brian Latimer, Derek K. Smith, Noemi Bender, Sarah Rohde, Kyle Mannion, Young Kim, Robert Sinard, Alexander Langerman, Arthur Fleischer, Carole Fakhry, Tim Waterboer, James L. Netterville

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Human papillomavirus 16 (HPV-16) E6 seropositivity is a promising early marker of human papillomavirus–driven oropharyngeal cancer (HPV-OPC), yet more sensitive imaging modalities are needed before screening is considered. The objective of this study was to determine the sensitivity of transcervical sonography (TCS) for detecting clinically apparent HPV-OPC in comparison with computed tomography (CT) and positron emission tomography (PET)/CT. Methods: Fifty-one patients with known or suspected HPV-OPC without prior treatment underwent oropharyngeal TCS and blood collection (for HPV multiplex serology testing). Eight standard sonographic images were collected; primary-site tumors were measured in 3 dimensions if identified. Each patient underwent a full diagnostic workup as part of standard clinical care. The pathologic details, HPV status, final staging, and imaging findings were abstracted from the medical record. The sensitivity of each imaging modality was compared with the final clinical diagnosis (the gold standard). Results: Twenty-four base of tongue cancers (47%), 22 tonsillar cancers (43%), and 2 unknown primary cancers (4%) were diagnosed; 3 patients (6%) had no tumors. All p16-tested patients were positive (n = 47). Primary-site tumors were correctly identified in 90.2% (95% confidence interval [CI], 78.6%-96.7%) with TCS, in 69.4% (95% CI, 54.6%-81.7%) with CT, and in 83.3% (95% CI, 68.6%-93.0%) with PET/CT. TCS identified tumors in 10 of 14 cases missed by CT and recognized the absence of tumors in 3 cases for which CT or PET/CT was falsely positive. The smallest sonographically identified primary-site tumor was 0.5 cm in its greatest dimension; the average size was 2.3 cm. Among p16-positive patients, 76.1% (95% CI, 61.2%-87.4%) were seropositive for HPV-16 E6. Conclusions: TCS and HPV-16 E6 antibodies are sensitive for the diagnosis of HPV-OPC.

Original languageEnglish
Pages (from-to)2658-2665
Number of pages8
Issue number11
StatePublished - Jun 1 2020

Bibliographical note

Publisher Copyright:
© 2020 American Cancer Society


  • human papillomavirus (HPV)
  • human papillomavirus 16 (HPV-16) E6 antibodies
  • human papillomavirus–driven oropharyngeal cancer (HPV-OPC)
  • oropharyngeal cancer
  • squamous cell carcinoma
  • transcervical sonography
  • ultrasound

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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