Abstract
Gastrointestinal endoscopy (GIE) performed by gastroenterologists is an important modality for early pharyngeal cancer detection. Human papillomavirus (HPV) is one of the causes of oropharyngeal squamous cell carcinoma (OPSCC). However, the prevalence of HPV-related OPSCC detected by GIE is currently unknown. We retrospectively analyzed 207 OPSCC from 2018 to 2022, where HPV infection was diagnosed by p16 immunohistochemistry. We compared detection modalities and evaluated the proportion of lesions detected by GIE in both p16-positive and p16-negative cases. Out of the 207 patients, 92 (44.4%) were p16-positive. p16-positive cases had significantly lower rates of alcohol use, smoking, and history of esophageal or head/neck squamous cell carcinoma (all p < 0.001). Only 4.3% of p16-positive cases were detected by GIE, compared to 44.3% of p16-negative cases (p < 0.001). p16-positive patients were often diagnosed at advanced stages and underwent transoral resection less frequently (2.2% vs. 31.3%, p < 0.001). In cT1 cases, GIE or laryngoscopy revealed that p16-positive lesions were typically protruding and white to normal-colored, while p16-negative lesions were predominantly flat and erythematous.
In conclusion, HPV-related OPSCC cases are rarely detected by GIE, and few cases are treated with minimally invasive transoral resection, indicating a need for improvement in early detection.