Cytopathology in focus: What’s new in ’25 head and neck SCC guideline?
August 2025—Human papillomavirus testing has become the standard of care in head and neck squamous cell carcinoma (HNSCC) because of the unique clinical features, staging, and treatment options for HPV-associated HNSCC. HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) exhibits a favorable prognosis and improved response to chemoradiation compared with conventional HNSCC and non-HPV-associated forms, and reporting the HPV status is frequently part of clinical trial enrollments. Many patients with OPSCC present with enlarged level II or III cervical lymph nodes and, as a result, cervical lymph node fine-needle aspiration is often the first, and sometimes only, tissue obtained for diagnostic testing. With a growing menu of options available to test for HPV status, including polymerase chain reaction, DNA in situ hybridization, mRNA ISH, liquid-based HPV assays, and p16 immunohistochemistry, it is not always clear when and which HPV test to use, especially when the diagnosis is made on a cytology specimen.