Department of Pathology, Zeynep Kamil Maternity and Pediatric Research and Training Hospital, Istanbul, Turkey.
J Low Genit Tract Dis. 2013 Apr;17(2):154-9. doi: 10.1097/LGT.0b013e31825c33f9.
This study aimed to evaluate and reexamine materials of the patients with cervical biopsy revealing cervical intraepithelial neoplasia and their cone biopsies revealing no lesion.
Twenty-five patients with cervical biopsy revealing cervical intraepithelial neoplasia and cone biopsies revealing no lesion among 202 patients who had undergone cervical conization after colposcopically derived cervical biopsy between 2005 and 2011 were included in this study. Ki67 and P16 were applied to the all biopsy slides. The conization blocks of patients whose reevaluation results of the original biopsy slides were positive were completely sectioned to reexamine the presence of any lesion, and suspicious areas were stained with Ki67 and P16.
Of the 25 patients' punch biopsies, no lesion was detected in 13 patients. The false positivity of first punch biopsy (52%) was the main reason for negative cone biopsy result after positive punch biopsy. Punch biopsies of the other 12 patients confirmed the lesions previously diagnosed. The detailed examination of conization specimens of the latter group showed 3 new low-grade cervical intraepithelial neoplasia, which had not been identified before.
Discordance between cervical biopsy findings and cervical conization findings could result from misdiagnosis of cervical biopsy, failure in preparation of the whole conization material, and technical difficulties of conization. Ki67 and P16 staining can be used in such cases to clarify the diagnosis.
本研究旨在评估和重新检查宫颈活检显示宫颈上皮内瘤变且宫颈锥切未见病变的患者的标本。
本研究纳入了 2005 年至 2011 年间经阴道镜下宫颈活检后行宫颈锥切术的 202 例患者中，25 例宫颈活检显示宫颈上皮内瘤变且宫颈锥切未见病变的患者。对所有活检切片应用 Ki67 和 P16 进行检测。对重新评估原始活检切片结果为阳性的患者的锥切标本进行完全切片，以重新检查是否存在任何病变，并对可疑区域进行 Ki67 和 P16 染色。
在 25 例患者的活检中，13 例未见病变。首次活检的假阳性（52%）是宫颈活检阳性而宫颈锥切阴性的主要原因。另外 12 例患者的活检则证实了之前诊断的病变。对后者组的锥切标本进行详细检查，发现了 3 例新的低级别宫颈上皮内瘤变，这些病变之前未被识别。
宫颈活检和宫颈锥切结果不一致可能是由于宫颈活检的误诊、整个锥切标本制备失败以及锥切技术的困难所致。在这种情况下，可以使用 Ki67 和 P16 染色来明确诊断。
