加强宫颈癌筛查:p16/Ki-67双重染色作为一种有前景的分流策略的综述
Enhancing Cervical Cancer Screening: Review of p16/Ki-67 Dual Staining as a Promising Triage Strategy.
作者信息
Ouh Yung-Taek, Kim Ho Yeon, Yi Kyong Wook, Lee Nak-Woo, Kim Hai-Joong, Min Kyung-Jin
机构信息
Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan-si 15355, Gyeonggi-do, Republic of Korea.
出版信息
Diagnostics (Basel). 2024 Feb 19;14(4):451. doi: 10.3390/diagnostics14040451.
Cervical cancer, primarily caused by high-risk human papillomavirus (HR-HPV) types 16 and 18, is a major global health concern. Persistent HR-HPV infection can progress from reversible precancerous lesions to invasive cervical cancer, which is driven by the oncogenic activity of human papillomavirus (HPV) genes, particularly E6 and E7. Traditional screening methods, including cytology and HPV testing, have limited sensitivity and specificity. This review explores the application of p16/Ki-67 dual-staining cytology for cervical cancer screening. This advanced immunocytochemical method allows for simultaneously detecting p16 and Ki-67 proteins within cervical epithelial cells, offering a more specific approach for triaging HPV-positive women. Dual staining and traditional methods are compared, demonstrating their high sensitivity and negative predictive value but low specificity. The increased sensitivity of dual staining results in higher detection rates of CIN2+ lesions, which is crucial for preventing cervical cancer progression. However, its low specificity may lead to increased false-positive results and unnecessary biopsies. The implications of integrating dual staining into contemporary screening strategies, particularly considering the evolving landscape of HPV vaccination and changes in HPV genotype prevalence, are also discussed. New guidelines and further research are necessary to elucidate the long-term effects of integrating dual staining into screening protocols.
宫颈癌主要由高危型人乳头瘤病毒(HR-HPV)16型和18型引起,是全球主要的健康问题。持续性HR-HPV感染可从可逆的癌前病变发展为浸润性宫颈癌,这是由人乳头瘤病毒(HPV)基因,特别是E6和E7的致癌活性驱动的。传统的筛查方法,包括细胞学检查和HPV检测,其敏感性和特异性有限。本综述探讨了p16/Ki-67双重染色细胞学在宫颈癌筛查中的应用。这种先进的免疫细胞化学方法能够同时检测宫颈上皮细胞内的p16和Ki-67蛋白,为对HPV阳性女性进行分流提供了一种更具特异性的方法。对双重染色法和传统方法进行了比较,结果显示它们具有高敏感性和阴性预测值,但特异性较低。双重染色法敏感性的提高导致CIN2+病变的检出率更高,这对于预防宫颈癌进展至关重要。然而,其低特异性可能导致假阳性结果增加和不必要的活检。文中还讨论了将双重染色法纳入当代筛查策略的意义,特别是考虑到HPV疫苗接种的不断发展以及HPV基因型流行情况的变化。需要新的指南和进一步的研究来阐明将双重染色法纳入筛查方案的长期效果。