【摘要】 目的探讨在液基细胞学(TCT)未明确意义的不典型鳞状上皮细胞(ASCUS)中,P16INK4A免疫细胞化学染色和高危型人乳头状瘤(HR-HPV)检测对宫颈上皮内高度病变(HSIL)的预测意义。方法应用免疫细胞化学方法检测P16INK4A在89例液基细胞学不典型鳞状上皮细胞(ASC-US 55例和ASC-H34例)中的表达,用第二代杂交捕获法(HC-2)检测每一患者的13种HR-HPV DNA,并同组织病理诊断结果比较。结果在89例ASCUS中,组织病理证实:HSIL(CIN2/3)22例,宫颈癌2例,占26.97%(24/89)。P16INK4A免疫细胞化学染色阳性26例中,组织病理证实:CIN2/320例,宫颈癌2例,CIN1和宫颈炎4例;HC-2 HR-HPV DNA检测阳性64例,组织病理证实:CIN2/321例,宫颈癌2例,CIN1和宫颈炎41例;差异有统计学意义(P<0.01)。P16INK4A免疫细胞化学染色对宫颈鳞状上皮内高度病变(HSIL)的阳性预测值(PPV)和特异性(Sp)分别为84.62%和93.85%,明显高于HC-2 HR-HPV DNA检测的PPV35.94%和Sp36.92%。结论在TCT-ASCUS中,P16INK4A特异免疫染色比HC-2 HR-HPV DNA检测能够更可靠地鉴别宫颈良、恶性疾病,二者联合检测将会为病人提供一种更有效、更合理的处理方案。更多还原

【Abstract】 Objective To study the predictive value of P16INK4A immunocytochemical stain and high-risk human papilomavirus (HR-HPV) testing for high-grade cervical intraepithelial neoplasia in liquid-based ThinPrep cytology test (TCT) containing atypical squamous cells of undetermined significance (ASCUS). Methods Immunocytochemical method was used to detect the expression of P16INK4A in 89 cases of TCT-ASCUS. By using Hybrid Capture 2 (HC-2), 13 types of the HR-HPV DNA of each case were detected. Then the results were compared with follow-up histological pathology result. Results Of the 89 cases of ASCUS, histological pathology revealed that there were 22 cases of cervical intraepithelial neoplasias (CIN)2/3 and 2 cases of cervical cancer (26.97%, 24/89). P16INK4A was positive in 26 of 89 ASCUS containing 20 cases of CIN2/3, 2 cases of cervical cancer, and 4 csaes of cervicitis/CIN1 diagnosed histopathologically. HC-2 testing was positive in 64 cases of patients with ASCUS containing 21 cases of CIN2/3, 2 cases of cervical cancer, 41 cases of cervicitis/CIN1 diagnosed histopathologically. The difference in the rates of significant cervical lesion between P16INK4A and HR-HPV was significant (P<0.01). The positive predictive value (PPV, 84.62%) and specificity (Sp, 93.85%) of P16INK4A for the high-grade squamous intraepithelial lesion (HSIL) was significantly higher than the PPV (35.94%) and Sp (36.92%) of HC-2. Conclusion For ASCUS of cytological diagnosis, P16INK4A special immunochemical stain is more reliable to differentiate the malignant disease from the benign diseases in the cervix than HC-2 HR-HPV DNA testing. The combined detection of HR-HPV and P16INK4A will provide more effective and suitable management for the patients with ASCUS.更多还原