p16/Ki-67免疫组化染色阳性对宫颈低级别鳞状上皮内病变临床处理的意义

Significance of p16/Ki-67 immunohistochemical staining in treatment of cervical LSIL

目的分析宫颈组织病理学检查为低级别鳞状上皮内病变(LSIL)的患者行宫颈锥切术后病理、HPV转归情况,探讨宫颈活检病理为LSIL的临床处理决策。方法回顾性分析2015年1月至2018年12月浙江省立同德医院收治的经阴道镜活检宫颈组织病理学结果提示宫颈LSIL患者146例,均行宫颈组织p16/Ki-67免疫组化染色检测,并行宫颈锥切术治疗。观察患者宫颈锥切术后病理学结果;比较p16/Ki-67免疫组化染色阳性与阴性患者术后病理学结果;分析患者宫颈组织Ki-67免疫组化染色程度与术后病理学结果的相关性;观察患者宫颈锥切术前与术后HPV检测结果。结果146例宫颈LSIL患者宫颈锥切术后病理学结果显示,黏膜慢性炎36例,LSIL 91例,高级别鳞状上皮内病变(HSIL)19例,符合率为62.33%(91/146),病理升级率为13.01%(9/146)。p16/Ki-67染色阳性与阴性患者分别为91、55例,染色阳性患者中病理升级者所占比例明显高于染色阴性患者(15.38%比9.09%,P<0.05)。患者宫颈组织Ki-67免疫组化染色程度与术后病理学级别呈正相关(r=0.335,P<0.05),即染色程度越重,术后病理学级别越高。宫颈锥切术后3个月HPV转阴率为88.89%(120/135)。结论对于经阴道镜活检宫颈组织LSIL者,若p16/Ki-67免疫组化染色阳性,特别是Ki-67免疫组化染色程度较重者,临床可建议直接行宫颈锥切术,而不是随访,避免高级别病变的漏诊、持续及进展,减轻患者的精神负担。

Objective To investigate the clinical significance of p16/Ki-67 immunohistochemical staining in treatment of patients with cervical low-grade squamous intraepithelial lesion(LSIL).Methods One hundred and forty-six patients with cervical LSIL diagnosed by transcervical colposcopic biopsy who were admitted to the Zhejiang Provincial Tongde Hospital between January 2015 and December 2018 were retrospectively evaluated.The p16/Ki-67 immunohistochemical staining in cervical tissue was performed and all patients received cervical conization.The correlation between Ki-67 immunohistochemical staining and postoperative pathological results was analyzed,and the results of HPV testing before and after cervical conization were compared.Results The postoperative pathological results showed that there were 36 cases of chronic mucositis,91 cases of LSIL,19 cases of high-grade squamous intraepithelial lesion(HSIL).The coincidence rate was 62.33%(91/146),and the pathological upgrading rate was 13.01%(19/146).There were 91 cases with p16/Ki-67 staining positive and 55 cases with staining negative.The proportion of patients with pathological upstaging was significantly higher in double staining positive patients than in double staining negative patients(15.38%vs 9.09%,P<0.05).The degree of Ki-67 immunohistochemical staining was positively correlated with the grade of postoperative pathology(r=0.335,P<0.05).The HPV negative conversion rate at 3 months after cervical conization was 88.89%(120/135).Conclusion For patients with cervical LSIL diagnosed by transcervical colposcopic biopsy,if the p16/Ki-67 immunohistochemical staining positive,especially the Ki-67 staining degree is high,cervical conization should be performed directly to avoid missed diagnosis and progress to high-grade lesions.