Stănculescu Ruxandra, Brătilă Elvira, Bauşic Vasilica, Vlădescu Teodora
"Carol Davila" University of Medicine and Pharmacy, Department of Pathology, "St. Pantelimon" Clinical Emergency Hospital, Bucharest, Romania;
Rom J Morphol Embryol. 2013;54(4):1061-5.
Assessing the hypothesis that p16(INK4a) immunocytochemistry (ICC) has better relevance than Human Papillomavirus (HPV) testing at detecting high-grade cervical intraepithelial neoplasia (HGCIN) upon histopathological diagnosis in women with abnormal cytologies such atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL).
A retrospective study of 63 selected cases (22 with ASC-US and 41 with LSIL) was performed at "St. Pantelimon" Clinical Hospital, Bucharest, Romania, using p16(INK4a) ICC and Linear Array HPV Genotyping Test. All cases have been followed-up by colposcopy and biopsies. The sensitivity and specificity of p16(INK4a) and HPV were analyzed by chi-squared test.
LSIL cytologies were more likely to be p16(INK4a) positive than those with ASC-US: OR=3.1, 95% CI (1.06-9.11). The processed data show that in women with LSIL the sensitivity of p16(INK4a) is 37.5% higher than that of high-risk(hr)-HPV (p=0.0050), whereas in ASC-US it is 44.5% higher (p=0.0577). In ASC-US, p16(INK4a) has a higher specificity (84.62%) than hr-HPV (53.85%); for LSIL cytologies, this difference is less steep: 58.82% for p16(INK4a) as compared to 47.06% for HPV.
The p16(INK4a) is significantly more sensitive than hr-HPV in both low-grade abnormal cytologies and has higher specificity than HPV testing to detect HGCIN, mainly in women with ASC-US cytologies. Only women with ASC-US and LSIL cytologies who test positive for p16(INK4a) should be directed to colposcopy and/or biopsy. p16(INK4a) is a suitable immunocytochemical marker which increases the accuracy of diagnosis at women with low-grade cytologic abnormality.
评估在对细胞学异常（如意义不明确的非典型鳞状细胞（ASC-US）或低级别鳞状上皮内病变（LSIL））的女性进行组织病理学诊断时，p16（INK4a）免疫细胞化学（ICC）在检测高级别宫颈上皮内瘤变（HGCIN）方面比人乳头瘤病毒（HPV）检测具有更好相关性的假设。
在罗马尼亚布加勒斯特的“圣潘泰利蒙”临床医院，对63例选定病例（22例ASC-US和41例LSIL）进行了回顾性研究，采用p16（INK4a）ICC和线性阵列HPV基因分型检测。所有病例均通过阴道镜检查和活检进行随访。通过卡方检验分析p16（INK4a）和HPV的敏感性和特异性。
LSIL细胞学比ASC-US更可能p16（INK4a）呈阳性：比值比（OR）=3.1，95%置信区间（CI）（1.06 - 9.11）。处理后的数据显示，在LSIL女性中，p16（INK4a）的敏感性比高危（hr）-HPV高37.5%（p = 0.0050），而在ASC-US中则高44.5%（p = 0.0577）。在ASC-US中，p16（INK4a）的特异性（84.62%）高于hr-HPV（53.85%）；对于LSIL细胞学，这种差异较小：p16（INK4a）为58.82%，而HPV为47.06%。
在低级别异常细胞学中，p16（INK4a）比hr-HPV明显更敏感，并且在检测HGCIN方面比HPV检测具有更高的特异性，主要是在ASC-US细胞学的女性中。只有p16（INK4a）检测呈阳性的ASC-US和LSIL细胞学女性才应接受阴道镜检查和/或活检。p16（INK4a）是一种合适的免疫细胞化学标志物，可提高低级别细胞学异常女性的诊断准确性。
