液基细胞学剩余标本细胞块中 p16INK4A、Ki-67 和人乳头瘤病毒 L1 衣壳蛋白免疫化学染色的诊断价值。

Diagnostic value of p16INK4A, Ki-67, and human papillomavirus L1 capsid protein immunochemical staining on cell blocks from residual liquid-based gynecologic cytology specimens.

机构信息

Department of Histopathology, First Affiliated Hospital, Sun Yat-sen (Zhongshan) University, Guangzhou, People's Republic of China.

出版信息

Cancer Cytopathol. 2010 Feb 25;118(1):47-55. doi: 10.1002/cncy.20061.

DOI:10.1002/cncy.20061

PMID:20069634

Abstract

BACKGROUND

This study was conducted to evaluate the reliability and role of cell block preparations in the diagnosis of neoplastic and preneoplastic lesions of the cervix and to improve the value of cell block preparations in diagnosing and predicting the prognosis of cervical lesions through immunostaining of p16INK4A (p16), Ki-67, and human papillomavirus (HPV) L1 capsid protein (HPV L1).

METHODS

In total, 138 specimens were diagnosed on liquid-based cytology (LBC) and cell block preparations, and 63 specimens were subjected subsequently to tissue follow-up and immunostaining for p16, Ki-67, and HPV L1 on cell block sections.

RESULTS

In 42 specimens that were diagnosed as low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion (HSIL), and squamous cell carcinoma (SCC) on cell blocks, 38 specimens (90.5%) were confirmed by histopathologic reports, and there was slightly better than 81.6% agreement between LBC and tissue follow-up. Immunointensity and cells that were positive for p16 were enhanced according to increased pathologic grade and differed statistically between cervical intraepithelial neoplasia 1 (CIN-1) and CIN-2/CIN-3 as well as SCC. The positive rates of HPV L1 decreased gradually according to the severity of cervical neoplasia, and HPV L1/p16 expression patterns were related to the severity of cervical lesions.

CONCLUSIONS

The cell block preparation technique was complementary to LBC, and the authors concluded that the application of LBC combined with cell block preparations may improve the diagnostic accuracy of cytology. Immunostaining for p16 and Ki-67 on cell block preparations can help to improve the diagnostic accuracy of HSIL and SCC. A combined expression pattern of p16 and HPV L1 may serve as a valuable index for predicting prognosis and follow-up of cervical dysplastic lesions.

摘要

背景

本研究旨在评估细胞块制备在诊断宫颈肿瘤性和癌前病变中的可靠性和作用，并通过免疫染色 p16INK4A（p16）、Ki-67 和人乳头瘤病毒（HPV）L1 衣壳蛋白（HPV L1）来提高细胞块制备在诊断和预测宫颈病变预后中的价值。

方法

共对 138 例液基细胞学（LBC）和细胞块制备标本进行了诊断，随后对 63 例标本进行了组织随访，并对细胞块切片进行了 p16、Ki-67 和 HPV L1 的免疫染色。

结果

在 42 例细胞块诊断为低级别鳞状上皮内病变、高级别鳞状上皮内病变（HSIL）和鳞状细胞癌（SCC）的标本中，38 例（90.5%）得到组织病理学报告的证实，LBC 和组织随访之间的一致性略高于 81.6%。免疫强度和 p16 阳性细胞随着病理分级的增加而增强，在 CIN-1 和 CIN-2/CIN-3 以及 SCC 之间存在统计学差异。随着宫颈癌严重程度的增加，HPV L1 的阳性率逐渐降低，HPV L1/p16 表达模式与宫颈病变的严重程度相关。