p16、Ki-67在宫颈鳞状上皮病变分级诊断中的意义

目的:探讨p16、Ki-67联合应用在宫颈鳞状上皮病变分级诊断中的意义.方法:采用免疫组化方法检测117例宫颈各类病变活检组织中p16、Ki-67蛋白表达情况,并对该组患者液基薄层细胞学(TCT)、高危型人乳头瘤病毒基因检测(HPV-DNA)结果进行比较.结果:根据HE组织学形态,结合免疫组化染色结果修订原有诊断,其中LSIL、HSIL的构成比差异有统计学意义.p16在LSIL、HSIL中的阳性表达率分别为0.00%、97.30%,Ki-67则分别为21.57%、67.58%(P<0.05).TCT和HPV-DNA检测HSIL的敏感度89.19%,特异度39.61%.联合应用p16、Ki-67的敏感度46.67%,特异度95.74%.结论:联合免疫组化染色检测p16、Ki-67可作为宫颈鳞状上皮病变分级诊断的重要标记物.联合TCT、HPV-DNA在宫颈癌筛查中有较高的敏感度,但特异度有限,需与p16、Ki-67免疫组化染色相结合.

The significance of p16 and Ki-67 testing in grading diagnosis of cervical squamous in-traepithelial lesions

Objective:To investigate the significance of p16 and Ki-67 testing in grading diagnosis of cervical squamous intraepithelial lesions. Methods:One hundred and seventeen cervical biopsy specimens were collected from different grades of cervical intraepithelial lesions. The expressions of p16 and Ki-67 were evaluated by immunohisto chemical staining. Cervical smears were tested for Thinprep cytology test and high-risk human papilloma virus. Re-sults:The differences were statistically significant between the constituent ratios of low-grade squamous intraepitheli-al lesions(LSIL)and high-grade squamous intraepithelial lesions(HSIL)(P<0. 05). The positive expression ratesofp16inLSILandHSILwere97.30% and0.00%,respectively(P<0.05).Ki-67rateswere67.58%and 21. 57%(P<0. 05). The sensitivity and specificity of combination of TCT and HPV - DNA were 89. 19%, 39. 61%,respectively. While the sensitivity and specificity of p16,Ki-67 staining were 46. 67%,95. 74%,respec-tively. Conclusion:It plays a significant role in distinguishing LSILs from HSILs in which cervical biopsy specimens were tested by p16 and Ki-67 immunohistochemical stain. The positive expression rates of p16 and Ki-67 were cor-related with the severity of cervical disease. The combination of TCT and HPV-DNA has a high sensitivity but with a low specificity in screening for cervical carcinoma. p16 and Ki-67 immunohistochemical staining should be tested.