p16^INK4a在宫颈液基细胞学辅助筛查中的标记意义

Role of p16^INK4a as a biomarker in liquid-based cervical cytology screening

目的评价p16^INK4a在宫颈液基细胞学检查中的标记意义。方法收集74例宫颈外口和颈管的脱落细胞标本，分别进行液基细胞学检测和p16^INK4a免疫细胞化学染色，并应用杂交捕获二代法检测高危人乳头瘤病毒（HR—HPV）感染。结果74例标本中，细胞学诊断未见癌细胞或癌前病变细胞（阴性）10例，意义不明的不典型鳞状细胞（ASC—US）15例，鳞状上皮内低度病变（LSIL）28例，不除外上皮内高度病变的不典型鳞状细胞（ASC—H）5例，鳞状上皮内高度病变（HSIL）11例，鳞状细胞癌（SCC）5例。各级别病变中，HR—HPV阳性者分别为1、4、3、9、7和5例，p16^INK4a免疫细胞化学染色阳性者分别为2、5、3、8、9和5例。随着宫颈病变级别的上升，HR—HPV和p16^INK4a免疫细胞化学染色阳性率均增高。结论p16^INK4a免疫细胞化学染色增强了对不典型细胞的区分能力，可以提高宫颈癌筛查的准确性。

Objective In cervical lesions, the overexpression of p16^INK4a has been reported to be closely associated with human papillomavirus （HPV） infection. This study is designed to evaluate the role of p16^INK4a as a biomarker in liquid-based cervical cytology screening. Methods Seventy-four specimens from the patients in our hospital were collected for this study. After cytological examination with liquid-based cervical smears, high-risk HPV （HR-HPV） DNA was then detected by Hybrid Capture Ⅱassay, and the rest cells were immunostalned for p16^INK4a. Results Of the 74 specimens, 10 were diagnosed as negative, 15 as atypical squmous cells of undetermined significance （ASC-US）, 28 as low-grade squamous intraepithelial lesion （LSIL） , 5 as atypical squmous cells which could not be excluded as HSIL （ASC-H） , 11 high-grade squamous intraepithelial lesion （HSIL） and 5 as squamous cell carcinoma （SCC）. The positive specimens of p16^INK4a were 2, 5, 8, 3, 9, 5, respectively, in the above subgroups; meanwhile, the positive specimens of HR-HPV were 1, 4, 9, 3, 7, 5, respectively, in the above groups. The positive rate of both p16^INK4a and HR-HPV in HSIL, ASC-H and SCC were obviously higher than that in LSIL, ASC-US and negative cases. Conclusion Positive rate of p16^INK4a and HR-HPV is highly correlated with the grade of the cervical lesion, p16^INK4a immunocytochemical staining may be used as a biomarker to increase the sensitivity of cervical cytology screening and the specificity of HPV test.