ArticleCureus2026
Performance and Cost-Effectiveness of Tumor Tissue-Modified Viral (TTMV)-Human Papillomavirus (HPV) DNA for Surveillance of HPV-Associated Oropharyngeal Cancer Compared With Standard Positron Emission Tomography (PET).
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
introductionThe standard of care for surveillance of human papillomavirus (HPV)-associated oropharyngeal cancer squamous cell carcinoma (OPSCC) is post-treatment positron emission tomography/computed tomography (PET/CT) imaging. There has been increasing interest in utilizing plasma tumor tissue-modified viral (TTMV)-HPV DNA as part of the diagnostic and surveillance paradigm. Methodology: In this single-institution retrospective analysis, we assessed the performance and cost-effectiveness of surveillance TTMV-HPV DNA in HPV-associated OPSCC among patients who underwent definitive or adjuvant radiation treatment. Patients included in our analysis underwent a three-month post-treatment PET scan and three-month TTMV-HPV DNA testing, with subsequent testing per the provider's discretion at follow-up. Markov decision tree analysis was performed to evaluate the cost-benefit of using TTMV-HPV DNA testing as part of the surveillance paradigm, particularly when a PET/CT image was deemed equivocal. Results: From 2018 to 2023, 68 patients with HPV-associated OPSCC underwent post-treatment surveillance with PET/CT and TTMV-HPV DNA testing. For PET/CT surveillance, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 83.3%, 90.3%, 45.5%, and 98.2%, respectively. For surveillance with TTMV-HPV DNA, the sensitivity, specificity, PPV, and NPV were 66.7%, 98.4%, 80.0%, and 96.8%, respectively. Using Markov decision tree analysis, we assessed the net monetary benefit (NMB) of additional TTMV-HPV DNA testing when PET/CT was equivocal and the NMB of upfront TTMV-HPV DNA testing alongside PET/CT. In both scenarios, we noted that the NMB was greater with TTMV-HPV DNA (scenario 1: $16,925; scenario 2: $16,809) than with repeat PET/CT (scenario 1: $15,575; scenario 2: $15,504).
conclusionsThese findings suggest that TTMV-HPV DNA testing performs as well as, and is potentially more cost-effective than, gold-standard PET/CT imaging for the surveillance of HPV-associated OPSCC. Future randomized studies are needed to determine whether TTMV-HPV DNA testing alone could be sufficient for the surveillance of treated HPV-associated OPSCC.
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