通过子宫颈脱落细胞中P16INK4α的表达预测子宫颈高级别病变的价值

Evaluation of P16INK4α expression in Thinprep cervical specimens for the predication of high-grade cervical intraepithelial neoplasia

目的 探讨子宫颈（简称宫颈）脱落细胞中P16INK4α（P16）表达预测宫颈高级别病变的准确性.方法 对192例宫颈薄层液基细胞剩余标本液,采用免疫组化方法检测P16表达,同时行高危人乳头瘤病毒（HPV）检测,并以阴道镜下组织病理学检查结果为金标准,比较P16检测、宫颈细胞学检查和高危HPV检测预测宫颈高级别病变的准确性.结果 （1）正常组织、子宫颈上皮内瘤变（CIN）1、CIN 2、CIN 3和CA患者宫颈脱落细胞P16阳性表达率分别为16.3%、46.7%、93.8%、91.1%、100.0%.通过Spearman相关分析显示宫颈脱落细胞中P16阳性表达率与其组织学病变呈正相关,r=0.900,P＜0.05;（2）宫颈脱落细胞P16检测预测宫颈高级别病变的敏感性、特异性、阳性预测值、阴性预测值,准确率分别为94.1%、78.5%、77.7%、94.4%、85.4%;高危HPV检测（HC2）的敏感性、特异性、阳性预测值、阴性预测值、准确率分别为95.3%、56.1%、63.3%、93.8%、73.4%;宫颈细胞学检查的敏感性、特异性、阳性预测值、阴性预测值,准确率分别为82.4%、92.5%、89.7%、86.8%、88.0%;通过卡方检验显示宫颈脱落细胞P16检测特异性、阳性预测值和准确率高于高危HPV检测（P＜0.05）,宫颈脱落细胞P16相比细胞学检查准确性差异无统计学意义（P＞0.05）.结论 在宫颈癌筛查中,宫颈脱落细胞P16检测特异性、阳性预测值和准确率优于高危HPV检测.P16具有预测宫颈高级别病变的价值.

Objective To explore the value of P16 in the predication of high-grade cervical intraepithelial （HGCIN） by P16 expression in cervical specimens. Methods One hundred ninety-two residual ThinPrep samples were collected and detected by HPV DNA test and P16 detected by immunocytochemistry. All women underwent colposcopy and histological examination of biopsy specimen if needed. P16 test, cytology and HR-HPV DNA （HC2） test were compared based on histological examination of colposcopic biopsies. Results （1）The expression of P16 showed 16.3% in normal or inflammatory cases, 46. 7% in CIN 1,93. 8% in CIN 2, 91.1% in CIN 3 and 100. 0% in carcinoma. A positive relation between P16 and the grade of cervical lesions was observed by Spearman analysis （ P 〈 0. 05, r = 0. 900）.（2）By P16 test, the sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV） and accuracy for ≥CIN 2 were 94. 1%, 78.5% , 77.7%, 94.4% and 85.4% respectively. By HR-HPV DNA test, the sensitivity, specificity, PPV, NPV and accuracy for ≥ CIN 2 were 95.3%,56. 1%, 63. 3%, 93. 8% and 73.4% respectively. By cytological test, the sensitivity, specificity, PPV,NPV and accuracy for ≥ CIN 2 were 82.4%, 92. 5%, 89. 7%, 86. 8% and 88.0% respectively. There were significant difference of specificity, PPV and accuracy between P16 and HR-HPV DNA （ P 〈 0. 05 ）.And no significant difference of accuracy was found between P16 and cytology（ P 〉 0. 05）. Conclusion The specificity, PPV and accuracy of P16 are significantly higher than those of HR-HPV DNA. Thus P16 test is valuable to diagnose HGCIN in ThinPrep specimens.（P 〉 0. 05 ）. The recovery time, the operative frequency and intra-operative blood loss were significantly different in two groups. Conclusion Both LEEP and CO2 vaporization are both effective and reliable for the treatment of cervical intraepithelial neoplasia Ⅱ. However, pathological specimens may be harvested during LEEP. It is of vital importance to conduct preoperative colposcopic assessment and standard postoperative follow-ups.