p16^(INK4a)免疫细胞化学检测在筛查宫颈癌中的作用

The Usefulness of p16^(INK4a) in cytological screening of cervical carcinoma

目的探讨p16INK4a免疫细胞化学检测在筛查宫颈癌及其癌前病变中的作用。方法选择220例宫颈液基细胞学剩余标本,制作液基薄片进行p16INK4a免疫细胞化学检测,随访组织活检结果,并与高危人乳头瘤病毒(HR-HPV)DNA检测结果进行对照。结果p16INK4a在宫颈细胞学诊断的鳞状细胞癌(SCC)、鳞状上皮内高度病变(HSIL)、鳞状上皮内低度病变(LSIL)、非典型鳞状细胞-不除外上皮内高度病变(ASC-H)和非典型鳞状细胞-不能明确意义(ASC-US)病例的阳性表达率分别为100．0%(7／7)、92．2％(107／116)、24．3％(17／70)、100．0％(14／14)和36．4％(4／11)。150例p16INK4a阳性者中,111例有组织活检诊断,其中宫颈上皮内瘤变(CIN)2级及以上病变者97例(87．4％);70例p16INK4a阴性者中,18例有组织活检诊断,无一例CIN2及以上病变。p16INK4a在CIN2及以上病变与在CIN1之间的阳性表达率差异有统计学意义(P<0．01),而HR-HPV DNA的阳性率在两者之间差异无统计学意义。结论p16INK4a在宫颈HSIL及以上病变中高表达,有利于高危病例的筛选。

Objective To evaluate the value of p16^INK4a immuneytoehemieal examination in cytological screening of cervical carcinoma and precancerous lesions. Methods p16^INK4a immuneytoehemieal detection was performed on 220 specimens remaining from liquid-based cytology, followed up by biopsy histology , and compared with the results of high-risk human papillomavirus （ HR - HPV ） DNA tests. Results In patients with cytological diagnosis of squamous cell carcinoma （SCC） , high-grade squamous intraepitbelial lesion （HSIL）, low-grade squamous intraepithelial lesion （LSIL） , atypical squamous cells-cannot exclude HSIL （ASC-H） , and atypical squamous cells of undetermined significance （ASC-US）, the positive rates of p16^INK4a were 100.0% （7/7）, 92.2% （ 107/116）, 24.3% （ 17/70）, 100.0% （14/14） and 36.4% （4/ 11 ） , respectively. In 111 of the 150 p16^INK4a positive cases, we found 97 （87.4%） cases which had biopsy diagnosises of≥ CIN2, but none in 18 of 70 p16^INK4a negative cases was. The difference in the positive rates for p16^INK4a between cervical intraepithelial neoplasia （CIN）1 and ≥ CIN2 lesions had statistical significance （P 〈 0.01 ）, whereas for HR-HPV DNA test it was not. Conclusion p16^INK4a is over-expressed in ≥ HSIL, and it may be useful in cytological screening of high risk patients.