Pathology Department, Son Espases Hospital, Palma de Mallorca, Spain.
Gynaecology Department, San Pau Hospital, Barcelona, Spain.
Rev Esp Patol. 2024 Jul-Sep;57(3):169-175. doi: 10.1016/j.patol.2024.03.004. Epub 2024 May 3.
An accurate cytohistologic diagnosis is important to avoid overtreatment of cervical intraepithelial lesions. The three-tiered Cervical Intraepithelial Neoplasia (CIN) classification, grades 1, 2 and 3, despite poor agreement among pathologists in diagnosing CIN2, is still being used. The College of American Pathologists recommended an alternative two-tiered classification that has not yet been universally accepted. We review the diagnostic results of 286 biopsies performed by three pathologists using haematoxylin and eosin (H&E) and p16 to establish the level of agreement among the readers. Agreement between pathologists in diagnosing CIN2 with H&E was around 45% and improved to 86.7% when interpreting p16 stained biopsies without H&E; agreement with pathologist 3 was lower, around 60%. Discrepant results from one pathologist when assessing p16 highlights the decisive influence of individual criteria. P16 has shown to improve agreement between pathologists with previous good agreement, but did not correct it for the third pathologist. In equivocal cases, protein p16 is a useful conjunctive tool for a histologic diagnosis.
准确的细胞组织学诊断对于避免宫颈上皮内病变的过度治疗很重要。尽管病理学家在诊断 CIN2 时的共识较差，但仍在使用三级宫颈上皮内瘤变（CIN）分类，等级 1、2 和 3。美国病理学家学院推荐了一种替代的两级分类，但尚未被普遍接受。我们回顾了三位病理学家使用苏木精和伊红（H&E）和 p16 对 286 例活检的诊断结果，以确定读者之间的一致性程度。使用 H&E 诊断 CIN2 时，病理学家之间的一致性约为 45%，而在不使用 H&E 解读 p16 染色活检时，一致性提高到 86.7%；与病理学家 3 的一致性较低，约为 60%。一位病理学家在评估 p16 时的不一致结果突出了个别标准的决定性影响。p16 已被证明可以提高之前具有良好一致性的病理学家之间的一致性，但不能纠正第三位病理学家的一致性。在模棱两可的情况下，蛋白质 p16 是组织学诊断的有用辅助工具。
