宫颈鳞状上皮内瘤变二级命名法的临床应用

Application of 2-tiered nomenclature for cervical intraepithelial neoplasia in clinic

目的探讨2013年WHO关于宫颈鳞状上皮内瘤变二级命名法的临床应用及相关问题。方法采用免疫组化技术检测p16、Ki-67蛋白在111例宫颈良性反应性病变(良性病变组)、81例CIN1、39例CIN2患者组织中的表达情况。并分析宫颈低级别及高级别鳞状上皮内瘤变二级命名法中,不同级别病变与p16、Ki-67蛋白表达的关系。结果 p16在良性病变、CIN1和CIN2组中的阳性表达率分别为18.92%、41.98%和64.10%,良性病变组与CIN1、CIN2组比较,差异均有统计学意义(P<0.05);Ki-67在良性病变、CIN1和CIN2组中的阳性表达率分别为32.43%、32.10%和69.23%,CIN2组与CIN1组、良性病变组比较,差异均有统计学意义(P均<0.05)。p16和Ki-67蛋白联合检测:在良性病变、CIN1、CIN2组中,p16(+)/Ki-67(+)的表达率分别为11.71%、9.88%和43.59%,p16(+)/Ki-67(-)的表达率分别为7.21%、32.10%和20.51%;p16(-)/Ki-67(+)的表达率分别为20.72%、22.22%和25.64%;p16(-)/Ki-67(-)的表达率分别为60.36%、35.80%和10.26%。三组中p16阴性着色特点不同,Ki-67的阳性着色特点不同。结论 p16蛋白联合Ki-67可以很好地区分低级别和高级别宫颈鳞状上皮内瘤变,但其有赖于免疫组化判读标准的严格执行;同一级别不同的染色特点可能代表组织的不同生物学特性,但尚需大量的临床验证。

Objective To apply 2-tiered nomenclature of cervical intraepithelial neoplasia（CIN）in clinic,in order to unify the terminology and strengthen the knowledge of cervical precancer.Methods Immunohistochemistry was used to examine the expression of p16 and ki-67 in 111cases of cervical reactive changes,81 cases of CIN1and39 cases of CIN2.Results p16 expression was confirmed in 18.92%,41.98%,64.10%of cervical reactive changes,CIN1 and CIN2,respectively.Positive expression of Ki-67 was observed in 32.43%,32.10%,69.23%of cervical reactive changes,CIN1 and CIN2,respectively.There were significant difference in p16 among the various groups（P〈0.05）.No such finding was detected with Ki-67 among the groups（P〉0.05）.In cervical reactive changes,CIN1 and CIN2,the expression of p16（＋）/ki-67（＋）was 11.71%,9.88%,43.59%;p16（＋）/ki-67（-）was 7.21%,32.10%,20.51%;p16（-）/ki-67（＋）was 20.72%,22.22%,25.64%;p16（-）/ki-67（-）was 60.36%,35.80%,10.26%,respectively.The expression characteristics of p16 negative and ki-67 positive are different in the three groups.Conclusion p16 and ki-67 protein are very useful for 2-tiered nomenclature of CIN.Accuracy of this classification relies on immunohistochemical interpretation standard carrying out.The different staining characteristics in the same grade maybe represent different biological nature,but it still needs large clinical validation.