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目的探讨P16INK4A过表达在宫颈细胞学检查为非典型鳞状细胞-不能明确意义(ASCUS)时的诊断价值。方法对2007年1月至11月在上海市第十人民医院妇科就诊的75例细胞学检查报告为ASCUS的妇女进行阴道镜评估与镜下活检,并同时进行液基薄层细胞学检查(thinprep cytology test,TCT)样本、活检组织样本的P16INK4A过表达检测和高危人乳头瘤病毒DNA(HPV-DNA)检测。结果75例ASCUS患者中宫颈上皮内瘤变(CIN)的发生率为59%,其中高度病变的发生率为21%。随着宫颈病变程度的加重,高危HPV与P16INK4A阳性率逐渐上升。P16INK4A免疫细胞化学及免疫组织化学染色结果一致。在良性反应性病变中,仅有1例检出P16INK4A过表达,而高危HPV阳性率为39%,两者差异有统计学意义(χ2=9.09,P<0.01)。P16INK4A过表达检测从ASCUS中检出高度病变的特异度(84.75%)和敏感度(93.75%)均高于高危人乳头瘤病毒DNA检测(分别为55.93%,87.50%),并且有更高的阴性预测值及阳性预测值。结论P16INK4A过表达与宫颈癌前病变密切相关。P16INK4A过表达检测是一种有效的ASCUS分流管理手段,较高危HPV-DNA检测能更好地提高CIN的检出率,剔除ASCUS中的良性病变,避免不必要的阴道镜检查及创伤性活检。
Objective To investigate the diagnostic value of P16INK4A overexpression in the diagnosis of atypical squamous cell carcinoma (ASCUS). Methods Seventy-five women with ASCUS who underwent gynecological examinations at the Tenth People’s Hospital of Shanghai from January 2007 to November 2007 underwent colposcopy and microscopic biopsy. Thinprep cytology test (TCT), P16INK4A overexpression in biopsy samples and high-risk human papillomavirus DNA (HPV-DNA). Results The incidence of cervical intraepithelial neoplasia (CIN) in 75 ASCUS patients was 59%, of which the incidence of highly pathological lesions was 21%. With the severity of cervical lesions, high-risk HPV and P16INK4A positive rate gradually increased. P16INK4A immunocytochemistry and immunohistochemistry staining results. In benign reactive lesions, only 1 case detected P16INK4A overexpression, while the high-risk HPV positive rate was 39%, the difference was statistically significant (χ2 = 9.09, P <0.01). P16INK4A overexpression detected a high degree of specificity (84.75%) and sensitivity (93.75%) of high-grade lesions detected from ASCUS were higher than high-risk human papillomavirus DNA test (55.93%, 87.50%), and have higher Negative predictive value and positive predictive value. Conclusion P16INK4A overexpression is closely related to cervical precancerous lesions. The P16INK4A overexpression test is an effective ASCUS shunt management method. The higher-risk HPV-DNA test can better improve the detection rate of CIN, eliminate benign lesions in ASCUS, and avoid unnecessary colposcopy and traumatic biopsy.