Baak J P A, Kruse A-J, Robboy S J, Janssen E A M, van Diermen B, Skaland I
Stovagen University Hospital and the Gade Institute, University of Bergen, Bergen, Norway.
J Clin Pathol. 2006 Oct;59(10):1017-28. doi: 10.1136/jcp.2005.027839. Epub 2006 May 5.
The microscopic phenotype of cervical intraepithelial neoplasia (CIN) reflects a fine balance between factors that promote or reduce CIN development. A shortcoming of the current grading system is its reliance on static morphology and microscopic haematoxylin-eosin features of the epithelium alone. In reality, CIN is a dynamic process, and the epithelium may exhibit differing results over time. Functional biomarkers p16, Ki-67, p53, retinoblastoma protein cytokeratin (CK)14 and CK13, help in the assessment of an individual CIN's lesion's potential for progression and regression. The aggregate information provided by these biomarkers exceeds the value of the classic grading system. Consequently, many more CINs that will either regress or progress can be accurately identified. These findings agree with known molecular interactions between HPV and the host. For accurate interpretation of a CIN, it is essential that these biomarkers be determined quantitatively and separately in the superficial, middle and deep layers of the epithelium. Such geography-specific epithelial evaluations of quantitative biomarkers emphasise the dynamic nature of a particular CIN lesion, thereby changing the art of static morphology grading into dynamic interpretation of the diseased tissue, with a strong prognostic effect.
宫颈上皮内瘤变（CIN）的微观表型反映了促进或减少CIN发展的因素之间的微妙平衡。当前分级系统的一个缺点是仅依赖于上皮细胞的静态形态学和微观苏木精-伊红特征。实际上，CIN是一个动态过程，随着时间的推移上皮细胞可能会呈现出不同的结果。功能性生物标志物p16、Ki-67、p53、视网膜母细胞瘤蛋白、细胞角蛋白（CK）14和CK13有助于评估个体CIN病变的进展和消退潜力。这些生物标志物提供的综合信息超过了经典分级系统的价值。因此，可以准确识别出更多将会消退或进展的CIN。这些发现与已知的人乳头瘤病毒（HPV）与宿主之间的分子相互作用相符。为了准确解读CIN，必须在上皮细胞的表层、中层和深层分别对这些生物标志物进行定量测定。这种针对特定部位上皮细胞的定量生物标志物评估强调了特定CIN病变的动态性质，从而将静态形态学分级的技术转变为对患病组织的动态解读，具有很强的预后效果。
