p16/Ki67联合双染在宫颈病变筛查中的分流意义

目的探讨p16/Ki67联合双染检测(简称p16/Ki67)在宫颈低度鳞状上皮内病变(LSIL)/高度鳞状上皮内病变(HSIL)筛查中的分流意义及对LSIL转归的预测价值。方法收集2016年7月-2017年7月在北京大学第三医院及晋江市医院组织学证实为慢性宫颈炎、LSIL、HSIL及以上(简称HSIL+,包括HSIL和宫颈癌)的3组标本(分别是84例、110例、106例)为研究对象,回顾性分析细胞学标本的p16/Ki67结果,比较研究对象p16/Ki67结果的差异,分析p16/Ki67、TCT、HRHPV初筛方案的分流效果及其诊断HSIL+的效能。对确诊的110例LSIL患者随访2年,分析p16/Ki67检测结果与LSIL转归的关系。结果宫颈组织学结果为慢性宫颈炎、LSIL、HSIL+组p16/Ki67阳性率分别为11.90%、20.00%、88.68%,差异有统计学意义(P<0.05)。p16/Ki67诊断HSIL+病变的灵敏度、特异度、阳性预测值和阴性预测值分别是87.74%、81.44%、72.09%、92.40%。p16/Ki67阳性的LSIL患者病变进展率是p16/Ki67双染阴性的2倍,两者比较差异有统计学意义(P<0.05)。结论p16/Ki67阳性率与宫颈疾病的严重程度呈正相关。p16/Ki67检测诊断HSIL+具有较高的灵敏度和特异度,预测LSIL的转归具有一定的意义,可以降低阴道镜转诊率,提高转诊阴道镜病理活检者HSIL+病变的检出率,值得在临床中推广。

Shunt significance of p16/Ki67 double staining test in cervical lesions screening

Objective To investigate the significance of p16/Ki67 double staining(abbrebiation p16/Ki67)in the screening of lowgrade squamous intraepithelial lesions(LSIL)/high-grade squamous intraepithelial lesions(HSIL)of the cervix and its predictive value for the prognosis of LSIL.Methods The three groups of chronic cervicitis,LSIL,HSIL and above(HSIL+)(84,110,106,respectively)were collected from From the Third Hospital of Peking University and Jinjiang hospital from July 2016 to July 2017.The results of p16/Ki67 were analyzed retrospectively.The differences of p16/Ki67 results among the three groups were compared.The shunting effect of p16/Ki67,TCT,HR-HPV primary screening scheme and their efficiency of HSIL+diagnosis were analyzed.110 patients with LSIL were followed up for 2 years.The relationship between the results of p16/Ki67 and the outcome of LSIL was analyzed.Results The positive rates of p16/Ki67 in chronic cervicitis,LSIL and HSIL+groups were 11.90%,20.00%and 88.68%.The overall difference was statistically significant(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of p16/Ki67 were 87.74%,81.44%,72.09%and 92.40%,respectively.The progression rate of LSIL in p16/Ki67 positive patients was twice as high as that in p16/Ki67 negative patients(P<0.05).Conclusion The positive rate of p16/Ki67 is positively correlated with the severity of cervical diseases.The detection of p16/Ki67 has high sensitivity and specificity in the diagnosis of HSIL+,and has certain significance in predicting the outcome of LSIL.It can reduce the referral rate of colposcopy and improve the detection rate of HSIL+lesions in the patients who are referred to colposcopy for pathological biopsy.It is worth popularizing in clinical practice.