del Pino Marta, Garcia Sònia, Fusté Victòria, Alonso Immaculada, Fusté Pere, Torné Aureli, Ordi Jaume
Department of Obstetrics and Gynecology, Hospital Clínic, University of Barcelona Faculty of Medicine, Barcelona, Spain.
Am J Obstet Gynecol. 2009 Nov;201(5):488.e1-7. doi: 10.1016/j.ajog.2009.05.046. Epub 2009 Aug 15.
The objective of this study was to evaluate the usefulness of p16(INK4a) staining to classify cervical intraepithelial neoplasia grade 1 according to its progression/regression risk.
Patients with a histologic diagnosis of cervical intraepithelial neoplasia grade 1 were prospectively recruited (n = 138). Simultaneous detection of high-risk human papillomaviruses and p16(INK4a) evaluation were performed. Follow-up was conducted every 6 months by cytology and colposcopy and annually by high-risk human papillomavirus testing, for at least 12 months (mean, 29.0). Progression was defined as a histologic diagnosis of cervical intraepithelial neoplasia grades 2-3, regression as a negative cytology and high-risk human papillomaviruses, and persistence as a cytologic result of low-grade squamous intraepithelial lesions and/or a positive test for high-risk human papillomaviruses.
Progression was observed in 14 women (10.1%), 66 (47.6%) regressed, and 58 (42.0%) had a persistent disease. p16(INK4a) was positive in 77 (55.8%) initial biopsy specimens. Progression to cervical intraepithelial neoplasia grades 2-3 was identified in 14 of 77 (18.2%) women with positive and none of 61 (0.00%) women with negative p16(INK4a) immunostaining (P < .001).
p16(INK4a) negative cervical intraepithelial neoplasia grade 1 lesions rarely progress and may benefit from a less intensive follow-up.
本研究的目的是评估p16（INK4a）染色根据其进展/消退风险对1级宫颈上皮内瘤变进行分类的有用性。
前瞻性招募组织学诊断为1级宫颈上皮内瘤变的患者（n = 138）。同时进行高危型人乳头瘤病毒检测和p16（INK4a）评估。每6个月通过细胞学和阴道镜检查进行随访，每年通过高危型人乳头瘤病毒检测进行随访，至少持续12个月（平均29.0个月）。进展定义为组织学诊断为2 - 3级宫颈上皮内瘤变，消退定义为细胞学和高危型人乳头瘤病毒检测均为阴性，持续存在定义为低度鳞状上皮内病变的细胞学结果和/或高危型人乳头瘤病毒检测阳性。
14名女性（10.1%）出现进展，66名（47.6%）消退，58名（42.0%）疾病持续存在。77份（55.8%）初始活检标本中p16（INK4a）呈阳性。在77名p16（INK4a）免疫染色阳性的女性中有14名（18.2%）进展为2 - 3级宫颈上皮内瘤变，而61名p16（INK4a）免疫染色阴性的女性中无一例进展（P <.001）。
p16（INK4a）阴性的1级宫颈上皮内瘤变病变很少进展，可能受益于强度较低的随访。
