Akpolat Ilkser, Smith Debora A, Ramzy Ibrahim, Chirala Minni, Mody Dina R
Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
Cancer. 2004 Jun 25;102(3):142-9. doi: 10.1002/cncr.20258.
Cell blocks can be prepared from residual thin-layer cervicovaginal (ThinPrep) material and can be used in immunohistochemical staining assays for p16INK4a and Ki-67, which are surrogate markers related to human papillomavirus infection and cell proliferation, respectively. The objectives of the current study were 1) to investigate the feasibility and the role of cell block preparations in identifying significant neoplastic and preneoplastic lesions of the uterine cervix and 2) to assess the feasibility of using p16INK4a and Ki-67 immunohistochemical staining patterns on cell blocks to identify significant preneoplastic cervical lesions.
Cervicovaginal cytology specimens from 85 patients were analyzed. Cytologic diagnoses based on ThinPrep Papanicolaou test results were as follows: squamous cell carcinoma was diagnosed in 3 specimens, high-grade squamous intraepithelial lesions (HSIL) were diagnosed in 27 specimens, low-grade squamous intraepithelial lesions (LSIL) were diagnosed in 20 specimens, and atypical squamous cells of uncertain significance (ASCUS) were diagnosed in 11 specimens. Diagnoses of negativity for intraepithelial lesions or malignancy (NILM) were made in 24 specimens. Cell block sections were stained with hematoxylin and eosin and were immunostained with antibodies against p16INK4a protein and Ki-67 antigen.
The cytomorphologic diagnoses made using cell block preparations were as follows: SCC in 2 specimens, HSIL in 20 specimens, LSIL in 30 specimens, NILM in 32 specimens, and no diagnosis in 1 specimen. In 62 cases (73%), the diagnoses made using cell block preparations were in agreement with the ThinPrep diagnoses. Immunostaining of cell blocks for p16INK4a and Ki-67 exhibited a statistically significant association (P < 0.05) with the presence of significant lesions on either cell block or ThinPrep analysis.
To the authors' knowledge, p16INK4a has not been analyzed previously in ThinPrep cell blocks, and the correlation between Ki-67 expression and cell block diagnoses also has not been reported previously. The current results indicate that cell blocks prepared from residual ThinPrep material represent an additional reliable diagnostic tool in the evaluation of cervical samples. Furthermore, immunohistochemical studies may be helpful in differentiating significant preneoplastic changes from other cervical lesions, such as atrophy.
细胞块可由剩余的薄层宫颈阴道（ThinPrep）材料制备而成，并可用于p16INK4a和Ki-67的免疫组织化学染色检测，这两种分别是与人乳头瘤病毒感染和细胞增殖相关的替代标志物。本研究的目的是：1）探讨细胞块制备在识别子宫颈显著肿瘤性和肿瘤前病变中的可行性及作用；2）评估在细胞块上使用p16INK4a和Ki-67免疫组织化学染色模式来识别显著的肿瘤前宫颈病变的可行性。
分析了85例患者的宫颈阴道细胞学标本。基于ThinPrep巴氏试验结果的细胞学诊断如下：3例标本诊断为鳞状细胞癌，27例标本诊断为高级别鳞状上皮内病变（HSIL），20例标本诊断为低级别鳞状上皮内病变（LSIL），11例标本诊断为意义不明确的非典型鳞状细胞（ASCUS）。24例标本诊断为上皮内病变或恶性肿瘤阴性（NILM）。细胞块切片用苏木精和伊红染色，并用抗p16INK4a蛋白和Ki-67抗原的抗体进行免疫染色。
使用细胞块制备做出的细胞形态学诊断如下：2例标本为鳞状细胞癌，20例标本为HSIL，30例标本为LSIL，32例标本为NILM，1例标本未做出诊断。在62例（73%）病例中，使用细胞块制备做出的诊断与ThinPrep诊断一致。细胞块对p16INK4a和Ki-67的免疫染色与细胞块或ThinPrep分析中显著病变的存在具有统计学显著相关性（P < 0.05）。
据作者所知,此前尚未在ThinPrep细胞块中分析过p16INK4a，且此前也未报道过Ki-67表达与细胞块诊断之间的相关性。目前的结果表明，由剩余ThinPrep材料制备的细胞块是评估宫颈样本的另一种可靠诊断工具。此外，免疫组织化学研究可能有助于区分显著的肿瘤前变化与其他宫颈病变，如萎缩。
