利用液基细胞学标本评估p16(INK4a)/p21(WAF1/Cip1)免疫染色在子宫颈鳞状上皮内病变中的诊断和预后意义。
An evaluation of the diagnostic and prognostic significance of p16(INK4a) /p21(WAF1/Cip1) immunostaining in squamous intraepithelial lesions of the uterine cervix using liquid-based cytology specimens.
作者信息
Ishida Katsunari, Araki Asuka, Kobayashi Masayuki, Taniyama Kiyomi, Nabika Toru, Nagasaki Makoto
机构信息
Department of Clinical Laboratory, The National Hospital Organization Hamada Medical Center, Hamada, Japan; Department of Functional Pathology, Shimane University School of Medicine, Izumo, Japan.
出版信息
Diagn Cytopathol. 2014 Feb;42(2):125-33. doi: 10.1002/dc.23008. Epub 2013 Jun 11.
Human papillomavirus (HPV) infection frequently causes squamous intraepithelial lesions (SIL) of the uterine cervix and consequently gives rise to squamous cell carcinoma. It is therefore important to identify cases that potentially develop higher grades of SIL at an early stage of the disease. In this study, we thus investigated whether immunocytochemistry for p21(WAF1/Cip1) and p16(INK4a) could be applicable in the diagnosis and the prognostic prediction of SIL in combination with genomic analyses of HPV. The genomic analysis of high-risk HPV (hrHPV), which was done by reversed dot blotting and by in situ hybridization, and immunocytochemistry were performed on liquid-based cytological specimens. A cross-sectional study comprising 145 cases of NILM, ASC-US, LSIL, and HSIL indicated that the incidence of the positive cases for p16(INK4a) and p21(WAF1/Cip1) and hrHPV increased with the grade of SIL. A double positive status for p16(INK4a) and p21(WAF1/Cip1) was a significant discriminator between HSIL and LSIL/NILM, even when applied in conjunction with the genomic test for hrHPV (P = 0.006 by logistic regression analysis). However, a prospective study employing 61 NILM/ASC-US cases, revealed that the p16(INK4a) /p21(WAF1/Cip1) immunostaining was not a significant predictor for the progression of SIL, whereas the cytological diagnosis (NILM vs. ASC-US) and the infection status of hrHPV conferred significant effects on the prognosis. Immunostaining of p16(INK4a) and p21(WAF1/Cip1) provides additional information on the cytological diagnosis of SIL. A further analysis using a larger population is warranted to obtain a conclusive result regarding the prognostic significance of p16(INK4a) /p21(WAF1/Cip1) immunocytochemistry in the diagnosis of SIL.
人乳头瘤病毒(HPV)感染常导致子宫颈鳞状上皮内病变(SIL),进而引发鳞状细胞癌。因此,在疾病早期识别可能发展为更高级别SIL的病例非常重要。在本研究中,我们调查了p21(WAF1/Cip1)和p16(INK4a)的免疫细胞化学检测结合HPV基因组分析是否可用于SIL的诊断和预后预测。通过反向斑点杂交和原位杂交对高危HPV(hrHPV)进行基因组分析,并对液基细胞学标本进行免疫细胞化学检测。一项包含145例正常宫颈、非典型鳞状细胞意义不明确(ASC-US)、低度鳞状上皮内病变(LSIL)和高度鳞状上皮内病变(HSIL)病例的横断面研究表明,p16(INK4a)、p21(WAF1/Cip1)和hrHPV阳性病例的发生率随SIL级别升高而增加。即使与hrHPV基因组检测联合应用,p16(INK4a)和p21(WAF1/Cip1)双阳性状态也是HSIL与LSIL/正常宫颈之间的显著鉴别指标(逻辑回归分析P = 0.006)。然而,一项对61例正常宫颈/ASC-US病例的前瞻性研究显示,p16(INK4a)/p21(WAF1/Cip1)免疫染色并非SIL进展的显著预测指标,而细胞学诊断(正常宫颈与ASC-US)和hrHPV感染状态对预后有显著影响。p16(INK4a)和p21(WAF1/Cip1)免疫染色为SIL的细胞学诊断提供了额外信息。有必要使用更大样本量进行进一步分析,以得出关于p16(INK4a)/p21(WAF1/Cip1)免疫细胞化学在SIL诊断中预后意义的确切结果。