Abstract Background: Oropharyngeal squamous cell carcinoma (OPSCC) associated with human papillomavirus (HPV) has a distinct prognosis, necessitating accurate biomarker testing. The Royal College of Pathologists (RCPath) recommends p16 immunohistochemistry (IHC) as a surrogate marker for all new OPSCC diagnoses, with confirmatory HPV genotyping by in situ hybridization (ISH) in p16-positive cases. An initial 2023 audit in our department demonstrated 100% compliance with this two-step protocol. Methods: We conducted a re-audit of all newly diagnosed OPSCC cases from January to December 2024 to assess ongoing adherence to the RCPath guidelines. The audit standards were 100% compliance with p16 IHC testing and 100% compliance with HPV genotyping for p16-positive cases. Results: Compliance with initial p16 IHC testing and documentation remained at 100%. However, the re-audit revealed a decline in adherence to the recommendation for confirmatory HPV genotyping in p16-positive cases compared to the 100% rate achieved in the previous audit cycle. In the re-audit, six p16 positive cases did not undergo the HPV genotyping, bringing down the compliance to 76%. Conclusions: This re-audit reveals a specific deficit in completing the two-step HPV testing protocol for OPSCC, despite excellent initial p16 screening. The decline in genotyping adherence necessitates targeted quality improvement initiatives. We recommend implementing enhanced communication pathways and electronic tracking systems. Ongoing audit is vital to ensure these interventions restore and maintain optimal patient care standards.
Bano et al. (Thu,) studied this question.