Schmidt D
Institut für Pathologie und Zytologie Viersen, Gereonstr. 14a, 41747, Viersen, Deutschland.
Pathologe. 2019 Feb;40(1):7-12. doi: 10.1007/s00292-018-0561-4.
The histological and immunohistochemical evaluation of tissue samples obtained in the course of the investigation and treatment of precancerous squamous lesions of the cervix uteri is an essential task of the pathologist. Given the surprising variety of morphological findings, including the many possible differential diagnoses of dysplastic changes, this is not an easy task.
Biologically, only two prognostically different groups can be distinguished, which according to the WHO classification are referred to as low-grade or high-grade squamous intraepithelial lesions (LSILs or HSILs). An additional distinction as CIN1, CIN2 or CIN3 should also be made, in particular because CIN2 lesions represent a heterogeneous group of dysplastic changes.
The p16 biomarker, which has been widely studied, is extremely helpful in the diagnosis and differential diagnosis of these lesions, as regenerative and reparative changes as well as non-HPV-associated squamous cell metaplasia, are p16 negative or show patchy staining only. The indications for its use were clearly defined in the LAST project. In contrast to the diagnostic advantage, the prognostic significance of p16 in the low-grade intraepithelial lesions is controversial. Other markers such as CK7 and HPVE4 may help here. The immunohistochemistry for p16 may also be useful in examining the resection margins of a conization specimen, especially if thermoeffects make it difficult to make an unambiguous assessment. However, for the prognostic assessment of the clinical course after conization, the HPV test is more important because it better captures the risk of persistence or the risk of recurrence.
对子宫颈癌前鳞状病变进行调查和治疗过程中所获取组织样本的组织学和免疫组织化学评估是病理学家的一项重要任务。鉴于形态学发现的惊人多样性，包括发育异常变化的多种可能鉴别诊断，这并非易事。
从生物学角度来看，只能区分出两个预后不同的组，根据世界卫生组织的分类，分别称为低级别或高级别鳞状上皮内病变（LSILs或HSILs）。还应额外区分为CIN1、CIN2或CIN3，特别是因为CIN2病变代表一组异质性的发育异常变化。
经过广泛研究的p16生物标志物在这些病变的诊断和鉴别诊断中非常有帮助，因为再生和修复性变化以及非HPV相关的鳞状上皮化生，p16呈阴性或仅显示斑片状染色。LAST项目明确界定了其使用指征。与诊断优势相反，p16在低级别上皮内病变中的预后意义存在争议。其他标志物如CK7和HPVE4在此可能会有所帮助。p16免疫组织化学在检查锥切标本的切缘时也可能有用，特别是当热效应使得难以做出明确评估时。然而，对于锥切术后临床病程的预后评估，HPV检测更为重要，因为它能更好地捕捉持续风险或复发风险。
