p16 免疫组化染色对宫颈活检标本中鳞状细胞病变诊断的潜在影响：细胞学-组织学相关性观察。

Potential influence of p16 immunohistochemical staining on the diagnosis of squamous cell lesions in cervical biopsy specimens: observation from cytologic-histologic correlation.

机构信息

The Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina.

出版信息

Cancer Cytopathol. 2018 Dec;126(12):1003-1010. doi: 10.1002/cncy.22063. Epub 2018 Oct 11.

DOI:10.1002/cncy.22063

PMID:30307707

Abstract

BACKGROUND

The p16 immunohistochemical (IHC) marker has been used increasingly as an adjunct to morphologic assessment of cervical biopsies in which the differential diagnoses include high-grade squamous intraepithelial lesion (HSIL) and its mimics. The objective of this study was to assess the potential influence of p16 IHC staining on the evaluation of cervical biopsy as observed through cytologic-histologic correlation (CHC).

METHODS

Cervical biopsy samples that had cytologic diagnoses of either low-grade squamous intraepithelial lesion (LSIL) or HSIL and also had histologic follow-up were retrieved from the department database. CHC and the use of p16 IHC from 2 periods (group 1, 2008; group 2, 2014-2016) were compared and analyzed.

RESULTS

Histology on 452 samples from patients who had prior LSIL cytology in group 1 yielded 126 benign (27.9%), 272 LSIL (60.2%), and 54 HSIL (11.9%) diagnoses. By comparison, 491 samples from the patients in group 2 yielded 106 benign (21.6%), 277 LSIL (56.4%), and 108 HSIL (22.0%) diagnoses. The difference in CHC discrepancies between the 2 groups was significant (P = .0001), mainly because of the increased diagnosis of HSIL in group 2. Although p16 IHC was not applied to any sample from group 1, it was performed on 141 of 491 samples (28.7%) from group 2. Further follow-up of patients who had histologic HSIL revealed that residual HSIL was identified significantly more often in those who did not have p16 IHC applied in the preceding cervical biopsy than in those did (P = .0004). A similar comparison was performed between 113 patients from group 1 and 152 patients from group 2 who had a prior diagnosis of HSIL cytology, and the difference was statistically insignificant.

CONCLUSIONS

The use of p16 IHC on cervical biopsies in patients who had a prior cytologic diagnosis of LSIL may lead to greater detection and upgrading of HSIL, thereby compounding the discrepancy in CHC.

摘要

背景

p16 免疫组织化学（IHC）标志物已被越来越多地用作宫颈活检中形态学评估的辅助手段，其鉴别诊断包括高级别鳞状上皮内病变（HSIL）及其类似物。本研究的目的是评估 p16 IHC 染色对通过细胞学-组织学相关性（CHC）观察到的宫颈活检评估的潜在影响。

方法

从部门数据库中检索了细胞学诊断为低级别鳞状上皮内病变（LSIL）或 HSIL 且具有组织学随访的宫颈活检样本。比较并分析了来自 2 个时期（第 1 组，2008 年；第 2 组，2014-2016 年）的 CHC 和 p16 IHC 的使用情况。

结果

第 1 组中，126 例（27.9%）为良性、272 例（60.2%）为 LSIL 和 54 例（11.9%）为 HSIL 的组织学结果来自于先前 LSIL 细胞学的 452 例患者的活检样本。相比之下，第 2 组中 491 例患者的组织学结果为 106 例（21.6%）为良性、277 例（56.4%）为 LSIL 和 108 例（22.0%）为 HSIL。两组之间的 CHC 差异显著（P =.0001），主要是因为第 2 组中 HSIL 的诊断增加了。尽管第 1 组中没有对任何样本进行 p16 IHC 检测，但对第 2 组的 491 个样本中的 141 个进行了检测（28.7%）。对组织学 HSIL 患者的进一步随访发现，在前一次宫颈活检中未应用 p16 IHC 的患者中，残留 HSIL 的检出率明显高于应用 p16 IHC 的患者（P =.0004）。对第 1 组的 113 例和第 2 组的 152 例先前诊断为 HSIL 细胞学的患者进行了类似的比较，差异无统计学意义。