Sari Aslani Fatemeh, Zolmajdi Najmeh, Akbarzadeh-Jahromi Mojgan, Momtahan Mozhdeh, Torfenezhad Parnia
Maternal-fetal Medicine Research Center, Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.
Iran J Med Sci. 2020 Nov;45(6):469-476. doi: 10.30476/ijms.2020.72707.0.
Cervical conization is a standard diagnostic method for precancerous lesions. However, its results could be negative despite an initially positive punch biopsy. The present study aimed to re-evaluate pathological biopsies with Ki-67 and p16 immunostaining to assess the diagnostic accuracy of punch biopsies.
This retrospective study performed in Motahhari Clinic and Shahid Faghihi Hospital, (Shiraz, Iran). 88 punch and cone biopsy slides from 2007-2016 were re-evaluated by two pathologists, and the results were compared with the original diagnoses. Agreement between the initial diagnoses and re-evaluations and between our pathologists were assessed with the kappa coefficient. Twenty-two negative conization results after positive punch biopsy were re-sectioned and evaluated with Ki-67 and p16 immunostaining.
The overall agreement (kappa) between the primary punch diagnoses by the original pathologists and those made in the present study (by the first and second pathologists) before immunohistochemical (IHC) staining was 0.33 and 0.43, respectively. The kappa coefficient between punch biopsy diagnoses by the first and second pathologists before IHC staining was 0.73, while it increased to one after IHC staining with Ki-67 and p16. Out of the 22 specimens with the positive punch and negative cone biopsies on initial diagnosis, cervical intraepithelial neoplasia (CIN) was not confirmed in 11 specimens by our pathologists after IHC staining with Ki-67 and p16. These cases were reclassified as transitional metaplasia or acute/chronic cervicitis.
Punch biopsy can be misdiagnosed as CIN positive, leading to unnecessary conization. The use of Ki-67 and p16 markers as appropriate ancillary tests are recommended.
宫颈锥切术是癌前病变的标准诊断方法。然而，尽管最初的穿刺活检结果为阳性，但其结果仍可能为阴性。本研究旨在通过Ki-67和p16免疫染色重新评估病理活检，以评估穿刺活检的诊断准确性。
本回顾性研究在伊朗设拉子的Motahhari诊所和Shahid Faghihi医院进行。两名病理学家对2007年至2016年的88张穿刺活检和锥切活检玻片进行了重新评估，并将结果与原始诊断进行比较。使用kappa系数评估初始诊断与重新评估之间以及我们的病理学家之间的一致性。对穿刺活检阳性后锥切活检结果为阴性的22例病例进行重新切片，并用Ki-67和p16免疫染色进行评估。
在免疫组化（IHC）染色前，原始病理学家的初次穿刺诊断与本研究（由第一和第二病理学家）的诊断之间的总体一致性（kappa）分别为0.33和0.43。在IHC染色前，第一和第二病理学家的穿刺活检诊断之间的kappa系数为0.73，而在用Ki-67和p16进行IHC染色后增加到1。在最初诊断为穿刺活检阳性而锥切活检阴性的22个标本中，我们的病理学家在用Ki-67和p16进行IHC染色后，有11个标本未确诊为宫颈上皮内瘤变（CIN）。这些病例被重新分类为移行化生或急性/慢性宫颈炎。
穿刺活检可能被误诊为CIN阳性，导致不必要的锥切术。建议使用Ki-67和p16标记物作为适当的辅助检查。
