p16和人乳头瘤病毒检测在宫颈腺癌和宫内膜腺癌中的鉴别意义

目的探讨p16免疫组化染色和人乳头瘤病毒(HPV)DNA检测在鉴别宫颈腺癌(ECA)和子宫内膜腺癌(EMA)中的作用。方法 (1)采用免疫组化法检测41例ECA和72例EMA患者中p16的表达,采用着色范围和强度的半定量方法对结果进行评价,分析ECA和EMA患者中p16表达及与临床病理特征的关系。(2)杂交2代捕获法(HC-2)对41例ECA和46例EMA患者进行HPV DNA检测,分析二者的区别。结果 (1)p16在ECA和EMA的阳性率分别是97.5%(40/41)和80.6%(58/72),差异有统计学意义(P=0.009)。ECA患者中p16呈弥漫强阳性着色,EMA患者中则常呈局灶或斑片状着色。p16在ECA患者中的表达与淋巴结转移相关;p16在EMA患者中的表达与病理亚型、分化程度和国际妇产科协会(FIGO)分期有关。(2)ECA组中的HPV阳性率为22.0%(9/41),EMA组全部阴性,差异有统计学意义(P=0.001)。结论 p16和HPV检测对宫颈腺癌和宫内膜腺癌的鉴别有重要意义,可以为手术方式和治疗方案提供有价值的信息。

The differential significance of p16 expression and human papillomavirus detection in endocervical and endometrial adenocarcinomas

Objective To investigate the utility of p16 immunohistochemistry(IHC)and Human-papillomavirus(HPV) DNA testing in the distinction of endocerical adenocarcinomas(ECAs) and endometrial adenocarcinomas(EMAs).Methods p16 expression was detected by immunohistochemical examination of paraffin-embedded sections in 41 ECAs and 72 EMAs.p16 expression was interpreted using the semiquantitative scoring system in considering staining area extent and intensity.The relationship between p16 staining and clinicopathological features,such as pathological subtype,degree of differentiation,depth of invasion,lymph node metastasis and FIGO stage were also evaluated.Hybrid capture 2(HC2) for HPV DNA was also performed in 41 ECAs and 46 EMAs.Results The positive rate of p16 in ECAs was 97.5%(40/41),as compared with 80.6%(58/72) in EMAs(P=0.009).The tumor cells in ECA showed diffuse and strong expression of p16.On the contrary,EMAs exhibited focal staining pattern.Furthermore,p16 expression was associated with lymph node metastasis in ECAs.In EMAs,the expression was relevant to pathologic subtype,degree of differentiation and FIGO stage.The positive rate of HPV DNA in ECAs was 22.0%(9/41),but none of EMAs showed p16 expression(P=0.001).Conclusion p16 immunohistochemistry and HPV testing can be used to assist in the differentiation of ECA and EMA,especially in biopsy and curettage specimens prior to hysterectomy.The reasonable application of these two methods will be instructive for clinical doctors to choose the correct surgical approach and proper treatment program.