# Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

## TL;DR

This study shows that HPV-related throat cancer is often harder to diagnose due to its unique symptoms, leading to delays in treatment.

## Contribution

The study identifies specific clinical features of HPV-related OPSCC that contribute to diagnostic delays.

## Key findings

- HPV-related tumors more commonly present with a neck mass and less often with throat pain.
- Patients with HPV-related tumors were more likely to experience diagnostic delays.
- HPV-related tumors are harder to detect through physical exams and often result in non-diagnostic biopsies.

## Abstract

Introduction
 Human papillomavirus-related (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation.

Objective
 The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis.

Methods
 Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002–2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis.

Results
 p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-;
p
 < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-;
p
 < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed;
p
 = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-;
p
 = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-,
p
 = 0.03).

Conclusions
 Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment.