细胞块上检测P16、HPV16用于筛查ASCUS中高度宫颈上皮内瘤变的临床探讨

The significance of detecting P16,HPV16 expression in cervical deciduous cells on cell block of ASCUS to identify high grade squamous intraepithelial neoplasia

目的探讨利用细胞块技术,检测宫颈脱落细胞P16、HPV16表达在筛查ASCUS中高度宫颈上皮内瘤变的意义。方法选取TCT检测为ASCUS的120例患者,所有患者均行阴道镜下宫颈活检,取其TCT保存液中的剩余物质制备宫颈细胞块,然后,在细胞块上进行P16、HPV16免疫组化染色。结果1)120例ASCUS患者经阴道镜下宫颈活检病理学诊断结果为:宫颈炎64例,CINⅠ33例,CINⅡ17例,CINⅢ16例,其中高度宫颈上皮内瘤变者(CINⅡ、CINⅢ)为23例,占19.17%。2)ASCUS中P16阳性表达在宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ组分别为6.25%、51.52%、82.35%、83.33%。P16阳性表达率在宫颈炎组与CINⅠ组,CINⅡ组,CINⅢ组之间比较均有显著性差异(P<0.01)。以P16强阳性表达为判定标准,则检出高度宫颈上皮内瘤变的敏感性、特异性、阳性预测值、阴性预测值分别为78.26%、92.78%、72%、94.74%。3)ASCUS中HPV16阳性表达率在宫颈炎组、CINⅠ组、CINⅡ组、CINⅢ组分别为21.88%、39.39%、76.47%、83.33%,HPV16阳性表达率在宫颈炎组与CINⅡ组、CINⅢ组,CINⅠ组与高度宫颈上皮内瘤变组之间比较,均有显著性差异(P<0.01)。结论细胞块上检测P16,HPV16可用于ASCUS中高度宫颈上皮内瘤变筛查。

Objective To access the significance of detecting P16 and HPV16 expression in ASCUS to identify high grade squamous intraepithelial neoplasia. Methods Selected 120 patients with atypical squamous cells of undetermined significance after thinprep cericovaginal cytology examination and they were done cervical biopsy under the colposcope. Cell block be prepared from residual material of thinprep preserve solution, cell block section were immunostained with antibody P16n protein and antibody HPV16. Results （1） The result of being done cervicel biopsy under the colposcope were as follow： cervicitis in 64 specimens, CIN Ⅰ in 33 specimens, Cin Ⅱ in 17 specimens, C1NⅢ in 6 specimens, in these cases there were 19.17% high grade squamous intraepithelial neoplasia （CINⅡ, CINⅢ）.（2）Positive rate of immunostaining for P16 on cervical deciduous cells in cervicitis,CIN Ⅰ , CIN Ⅱ ,CINⅢ were 6.25%,51.52%,82.35%,83.33%, respectively. Immunostaining for P16 between eervicitis and C1NⅠ, cervicitis and CINⅡ, cervicitis and CINⅢ exhibited statistically significant associations （P〈0.01）. Assessment aaccording to the standard of intense expression, The sensitivity,the specificity,positive predictive value and negative predictive value for immunostaining of cervical deciduous cells for P16 to detect high grade squamous intraepithelial neoplasia was respectively 78.26% ,92.78% ,72% ,94.74%.（3） Positive rate of immunostaining of HPV16 on cervical deciduous cells in cervicitis,CINⅠ ,CINⅡ ,CINⅢ were 21.88%,39.39%,76.47%,83.33%, respectively. Immunostaining for HPV16 between cervicitis and CIN Ⅰ ,cervicitis and CINⅢ ,CINⅠ and high grade squamous intraepithelial neoplasia exhibited statistically significant association（P〈0.01）. Conclusion Detecting P16 and HPV16 expression in SACUS can identify the high grade squamous intraepithelial neeplasia.