病理学家在常规病理实践中使用 p16 和 ki-67 免疫组化染色诊断宫颈活检的变异性及其对宫颈上皮内瘤变诊断频率和细胞组织学相关性的影响。

Variability of pathologists' utilization of p16 and ki-67 immunostaining in the diagnosis of cervical biopsies in routine pathology practice and its impact on the frequencies of cervical intraepithelial neoplasia diagnoses and cytohistologic correlations.

机构信息

From the Department of Laboratory Medicine and Pathology, University of Minnesota Medical School (Drs Singh, Truskinovsky, Thyagarajan, Gulbahce, Manivel, and Pambuccian); the School of Nursing, University of Minnesota (Ms Savik); and the Cytology Laboratory, University of Minnesota Medical Center-Fairview (Mr Amirouche and Ms Holler), Minneapolis. Dr Pambuccian is now at the Department of Pathology, Loyola University Medical Center, Maywood, Illinois.

出版信息

Arch Pathol Lab Med. 2014 Jan;138(1):76-87. doi: 10.5858/arpa.2012-0472-OA.

DOI:10.5858/arpa.2012-0472-OA

PMID:24377814

Abstract

CONTEXT

The use of p16 in cervical biopsies improves the accuracy of cervical intraepithelial neoplasia (CIN) diagnosis and grading and decreases its interpathologist variability.

OBJECTIVE

To determine the impact of the frequency of use of p16 immunostains in cervical biopsies on pathologists' diagnoses of CIN grade 1 and grade 2 or above (CIN1 and CIN2+) and on cytohistologic correlations.

DESIGN

We identified all cervical biopsy specimens with cytologic correlations subjected or not to p16 staining from January 1, 2005, to September 30, 2010; calculated each pathologist's percentage of p16 use; and correlated it with their major cytohistologic discrepancy rates, CIN2+ diagnoses, and CIN1/CIN2+ ratios.

RESULTS

During the study period, each of the 23 pathologists interpreted 59 to 1811 (mean, 518) of 11 850 cervical biopsy specimens, used p16 for 0% to 21.31% (mean, 10.14%) of these, had CIN2+ detection rates of 9.5% to 24.1% (mean, 18.9%), and CIN1/CIN2+ ratios of 0.7 to 4.5 (mean, 1.5). Compared to the 12 "low users" of p16, who used p16 fewer times than the institution's mean for p16 use, the 11 "high users" of p16 diagnosed more biopsies (8391 versus 3459), had a lower rate of major cytohistologic discrepancies (12.62% versus 14.92%, P < .001), a higher rate of CIN2+ diagnoses (19.9% versus 16.4%, P < .001), a lower range of CIN2+ rates (15.0%-23.1% versus 9.5%-24.1%), and lower CIN1/CIN2+ ratios (1.2 versus 2.3).

CONCLUSIONS

We found a high intrainstitutional variability of p16 use in cervical biopsies, CIN2+ rates, and CIN1/CIN2+ ratios. Use of p16 for greater than 10% of cervical biopsies was associated with improved cytohistologic correlation rates and with lower variability in the frequencies of histologic diagnoses.

摘要

背景

在宫颈活检中使用 p16 可提高宫颈上皮内瘤变（CIN）诊断和分级的准确性，并降低其在病理学家之间的变异性。

目的

确定宫颈活检中 p16 免疫染色的使用频率对病理学家诊断 CIN1 级和 CIN2 级及以上（CIN1 和 CIN2+）的影响，以及与细胞组织学相关性的影响。

设计

我们从 2005 年 1 月 1 日至 2010 年 9 月 30 日，确定了所有具有细胞学相关性的宫颈活检标本，这些标本进行或未进行 p16 染色；计算了每位病理学家使用 p16 的百分比，并将其与主要细胞学差异率、CIN2+诊断和 CIN1/CIN2+比值相关联。

结果

在研究期间，23 位病理学家中的每一位都解释了 59 至 1811 例（平均 518 例）的 11850 例宫颈活检标本，他们使用 p16 的比例为 0%至 21.31%（平均 10.14%），CIN2+检出率为 9.5%至 24.1%（平均 18.9%），CIN1/CIN2+比值为 0.7 至 4.5（平均 1.5）。与 12 位“低使用 p16 的病理学家”相比，这些病理学家使用 p16 的次数少于机构平均使用 p16 的次数，11 位“高使用 p16 的病理学家”诊断了更多的活检标本（8391 例比 3459 例），主要细胞学差异率较低（12.62%比 14.92%，P<0.001），CIN2+诊断率较高（19.9%比 16.4%，P<0.001），CIN2+检出率范围较低（15.0%-23.1%比 9.5%-24.1%），CIN1/CIN2+比值较低（1.2 比 2.3）。