p16^(INK4a)/Ki67免疫细胞化学双染在检出宫颈癌及癌前病变中的作用

Detection of Cervical Cancer or Precancerous Lesion by p16^(INK4a)/Ki67 Dual Stain Cytology

目的:探讨p16^(INK4a)/Ki67免疫细胞化学双染在检出宫颈癌及癌前病变中的作用。方法:选择妇科门诊就诊妇女131名,平均年龄(39±10.73)岁,进行宫颈上皮细胞p16^(INK4a)/Ki67免疫细胞化学双染检测、宫颈细胞学检查和高危型HPV检测。p16^(INK4a)/Ki67双染采用CINtec PLUS细胞学试剂盒方法,宫颈细胞学应用Thinprep或Surepath液基薄片的方法,高危型HPV检测采用Cobas 4800检测系统。结果:p16^(INK4a)/Ki67免疫细胞化学双染检出CIN2及以上病变的灵敏度为92.8%,特异度为58.8%,AUC为0.773,高于细胞学检查(82.5%,44.1%,0.633);其特异度及AUC也明显高于高危型HPV检测(17.6%,0.562),差异有统计学意义(P<0.05)。p16^(INK4a)/Ki67免疫细胞化学双染联合细胞学检查漏诊率最低。结论:p16^(INK4a)/Ki67双染检测具有更高的灵敏性及特异性,降低了宫颈高级别鳞状上皮病变的漏诊率及过度诊断,有助于提高宫颈癌的检出率。

Objective： To investigate the effect of p161NK4a/Ki67 dual stain cytology on the detection of cervical cancer or precancerous lesion. Methods： The cervical cytology, hr HPV test, pl61NK4a/Ki67 dual stain cytology and biopsy were performed for a total of 131 women with an average age of 39 ：t： 10, 73 in outpatient of gynecologic department from July 2016 to Jan. 2017. CINtec Plus kit was used for p161Nxga/Ki67 dual stain cytology. Thinprep or Surepath liquid based cytol- ogy was applied for cytology test. Cobas 4800 system was chosen for hrHPV test. Results ： The sensitivity and specificity of p161NK4a/Ki67 dual stain cytology （92.8%, 58. 8% ） were significantly higher than those of the liquid based cytology （82.5%, 44.1% ） , and its specificity was much higher than that of rhHPV test （17.6%, P〈0.05） when CIN2 was set as the cutoff, p16INK4a/Ki67 dual stain cytology has the highest AUC （ 0. 773 ） among these three methods （ P 〈 0.05 ）. Combination of p16INK4a/Ki67 dual stain cytology and cervical liquid based cytology got the lowest omission diagnostic rate for CIN2 and greater lesions. Conclusion： p161NK4a/Ki67 dual stain cytology has relatively higher sensitivity and specifici- ty, thus can help decrease the omission diagnostic rate and over-diagnosis rate of high grade cervical squamous epithelial le- sions, as well as improve the detection rate of cervical cancer.