The incidence and detection of HPV in the upper aerodigestive tract using brush and biopsy techniques.

The association between human papillomavirus (HPV) and squamous carcinoma is well established. In the polymerase chain reaction (PCR) we have an effective technique for detecting small quantities of viral DNA, but the assay requires tissue taken at endoscopy to reveal the presence or absence of HPV. Brushings have been used effectively elsewhere in the body to obtain cytological material. This study set out to ascertain if sufficient viral DNA could be obtained, using a laryngeal brushing and the PCR, to detect the presence or absence of HPV. Six patients with squamous carcinoma of the larynx and seven controls who were having laryngoscopy for other reasons underwent laryngeal biopsy. In addition, in the patients with carcinoma, biopsies were taken at the tumour margins and brushings from both sites. The samples were tested for the presence of HPV types 6, 11, 16, 18 and 31 by means of the PCR. The distribution of HPV types was as expected in the biopsy specimens, but only one brushing detected any HPV type at all. We conclude that laryngeal brushing is an inadequate technique for assessing the presence of HPV in the larynx.