cyclin E、p16ink4、ki67的高度表达对宫颈癌高危人群筛查的意义

USEFULNESS OF CYCLIN E,P16INK4 AND KI67 OVEREXPRESSION IN CERVICAL EXFOLIATED CELLS FOR SCREENING PATIENTS AT HIGH RISK OF DEVELOPING CERVICAL CARCINOMA.

目的:探讨宫颈脱落细胞中cyclinE、p1 6ink4、ki6 7的高度表达对宫颈癌高危人群筛查的意义。方法:采用免疫组织化学方法对78例宫颈脱落细胞标本(不明意义的鳞状上皮非典型增生ASCUS 1 2例、宫颈上皮内瘤样病变CIN11 7例、CINⅡ～Ⅲ3 8例、浸润癌1 1例)进行cyclinE、p1 6ink4、ki6 7检测,实验数据进行χ2 检验及四格表Fisher确切概率计算。结果:cyclinE、p1 6ink 4、ki6 7在各级宫颈癌中的阳性率均较ASCUS组差异有非常显著意义(P <0. 0 0 5 ) ;cyclinE在CIN1 的表达率较其它各组也有非常显著意义( 91.4%均P <0.0 1 ) ;p1 6ink4、ki6 7均随着宫颈上皮细胞损伤程度加重而表达上升(P <0.0 0 5 ) ,在浸润癌阳性率达到最高(分别为1 0 0 %和90.9% )。CIN1 组3指标特异度均较高(分别为91.7%、1 0 0 %和91 .7% ) ,灵敏度cyclinE最高( 94. 1 % ) ,p1 6ink4与ki6 7均较低(分别为5 8.8%和4 7.1 % )。结论:采用宫颈脱落细胞检测cyclinE、p1 6ink 4、ki6 7中的1项或多项作为诊断指标应用于宫颈癌高危人群筛查,对降低筛查的假阳性和假阴性率,提高筛查的灵敏度和特异度具有重要意义。

Objective:To evaluate the usefulness of cyclin E,p16ink4 and ki67 overexpression in cervical exfoliated cells for screening patients at high risk of developing cervical carcinoma.Methods:Immuohistochemical analysis of cyclin E,p16ink4 and ki67 expression was performed on 78 cervical exfoliated epithelial samples,diagnosed as a typical squamous cells of undetermied significance ASCUS(12 cases),cervical intyaepithelial neoplasia(CIN)of type 1(17 cases),CIN 2-3(38 cases)and invasive carcinoma(11 cases);χ 2 test with Fisher Probabilities was used as statistical analysis.Results:Cyclin E,p16ink4 and ki67 were all overexpressed in cervical preneoplasial and neoplasial cells compared with little expressed in ASCUS(P<0.005).The degree of p16ink4 and ki67 expression correlated well with the degree of cervical neoplasia(P<0.005).Overexpression of cyclin E was present in CIN1(94.1%,P<0.01),p16ink4 and ki67 overexpressed in invasive carcinoma(100% and 90.9% respectively).The specificy of cyclin E,p16ink4 and ki67 in CIN1 was 91.7%、100% and 91.7% respectively.Otherwise,the higher sensitivity was only found at cyclin E(94.1%),p16ink4 and ki67 was only 58.8% and 47.1% respectively.Conclusion:The employment of cyclin E,p16ink4 and ki67 in combination for the primary screening of cervical cytology could not only reduce both the higher false-positive and false-negative rate of conventional Pap test,but also increase its specificy and sensitivity as well.Moreover,this techniqu migh be useful for frequent examination of the out clinical patients.