Walts Ann E, Lechago Juan, Hu Bing, Shwayder Marybeth, Sandweiss Lynn, Bose Shikha
Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Clin Med Pathol. 2008;1:7-13. doi: 10.4137/cpath.s501. Epub 2008 Feb 9.
Significant variation is reported in the diagnosis of HPV-associated AIN. We previously observed that band-like positivity for p16 in >90% of contiguous cells coupled with Ki67 positivity in >50% of lesional cells is strongly associated with high grade AIN. This study was undertaken to determine if addition of p16 and Ki67 immunostaining would reduce inter- and intraobserver variability in diagnosis and grading of AIN.
H&E stained slides of 60 anal biopsies were reviewed by three pathologists and consensus diagnoses were achieved: 25 negative, 12 low (condyloma and/or AIN I) and 23 high (9 AIN II and 14 AIN III) grade lesions. The H&E stained slides were diagnosed independently by three additional ("participant") pathologists. Several weeks later they re-examined these slides in conjunction with corresponding p16 and Ki67 immunostains.
Addition of p16 and Ki67 immunostains reduced intra- and interobserver variability, improved concurrence with consensus diagnoses and reduced two-step differences in diagnosis. Negative and high grade AIN diagnoses showed the most improvement in concurrence levels.
Addition of p16 and Ki67 immunostains is helpful in the diagnosis and grading of AIN.
据报道，人乳头瘤病毒（HPV）相关的肛门上皮内瘤变（AIN）的诊断存在显著差异。我们之前观察到，超过90%的连续细胞中p16呈带状阳性，同时超过50%的病变细胞中Ki67呈阳性，这与高级别AIN密切相关。本研究旨在确定添加p16和Ki67免疫染色是否会减少AIN诊断和分级中观察者间和观察者内的变异性。
三位病理学家对60份肛门活检的苏木精-伊红（H&E）染色切片进行了复查，并达成了共识诊断：25份为阴性，12份为低级别（湿疣和/或AIN I），23份为高级别（9份AIN II和14份AIN III）病变。另外三位（“参与”）病理学家独立诊断H&E染色切片。几周后，他们结合相应的p16和Ki67免疫染色重新检查了这些切片。
添加p16和Ki67免疫染色减少了观察者内和观察者间的变异性，提高了与共识诊断的一致性，并减少了诊断中的两级差异。阴性和高级别AIN诊断在一致性水平上改善最为明显。
添加p16和Ki67免疫染色有助于AIN的诊断和分级。
