免疫细胞化学在宫颈癌筛查中的作用。
Role of immunocytochemistry in cervical cancer screening.
作者信息
Shidham Vinod B
机构信息
Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center, and Detroit Medical Center, Detroit, Michigan, United States.
出版信息
Cytojournal. 2022 Jun 14;19:42. doi: 10.25259/CMAS_03_17_2022. eCollection 2022.
The cervical cancer screening has been based conventionally on cytologic analysis. With advances in understanding the role of human papillomavirus, cotesting has been applied. But most of the patients subjected to colposcopy did not benefit, except in cases with HSIL [high-grade squamous intraepithelial lesion] cytology. Because of this, a step to increase the sensitivity to detect cancers and pre-cancers but with higher specificity with minimal overdiagnosis leading to prevention of unindicated cervical biopsies is highly desired. Such triaging step in cases with abnormal screening results is expected to minimize invasive interventions because of low false positivity. With availability of methodologies leading to quantitatively and qualitatively enhanced cell-blocks from residual liquid based cytology specimens, immunostaining can be performed for multiple immunomarkers with potential objectivity to triage initial screening test results. This is enhanced further with inclusion of AV marker in the cell-blocks and application of SCIP (subtractive coordinate immunoreactivity pattern) approach. The cell-blocks are also resource for performing other ancillary studies including molecular pathology and proteomics/metabolomics as potential tests in future. This review explores application of residual liquid based cytology specimen for cell-blocking with application of ancillary studies in algorithmic manner as adjunct to ASCCP management guidelines for improved patient care.
宫颈癌筛查传统上基于细胞学分析。随着对人乳头瘤病毒作用认识的进步,联合检测已被应用。但大多数接受阴道镜检查的患者并未从中受益,除了那些具有高级别鳞状上皮内病变(HSIL)细胞学特征的病例。因此,非常需要采取一个步骤来提高检测癌症和癌前病变的敏感性,但要具有更高的特异性,同时尽量减少过度诊断,以避免不必要的宫颈活检。对于筛查结果异常的病例,这样的分流步骤有望将侵入性干预降至最低,因为假阳性率较低。随着能够从剩余的液基细胞学标本中定量和定性地增强细胞块的方法的出现,可以对多种免疫标志物进行免疫染色,从而有可能客观地对初始筛查测试结果进行分流。在细胞块中加入AV标记并应用减法坐标免疫反应模式(SCIP)方法可进一步增强这一效果。细胞块也是进行其他辅助研究的资源,包括分子病理学和蛋白质组学/代谢组学,作为未来可能的检测手段。本综述探讨了将剩余的液基细胞学标本用于细胞块制作,并以算法方式应用辅助研究,作为美国阴道镜和宫颈病理学会(ASCCP)管理指南的辅助手段,以改善患者护理。