p16/Ki-67双染在高级别宫颈上皮内瘤变诊断中的应用价值  

The value of p16/Ki-67 double staining in the diagnosis of high-grade cervical intraepithelial lesions

作　　者：杨旎[1] 陈飞[1] 孔令华[1] 霍霄 沈铿[1] Yang Ni;Chen Fei;Kong Linghua(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《现代妇产科进展》2021年第6期407-410,共4页Progress in Obstetrics and Gynecology

摘　　要：目的比较细胞学p16/Ki-67双染检测和高危型人乳头瘤病毒(hrHPV)检测对细胞学为无明确意义的非典型鳞状细胞(ASCUS)患者的分流作用与诊断效能。方法收集细胞学诊断为ASCUS,同时行hrHPV检测,并有宫颈组织病理学检查结果的患者信息。将剩余宫颈上皮脱落细胞标本进行p16/Ki-67免疫细胞化学双染检测,对比细胞学p16/Ki-67双染检测和hrHPV对宫颈上皮内瘤变(CIN2)级及以上病变的诊断效能。收集宫颈组织学标本,进行p16/Ki-67组织学双染,比较组织学p16/Ki-67双染结果与病理的符合度。结果细胞学p16/Ki-67双染的阳性率与病变程度大致呈正比,符合度高于hrHPV检测(P=0.6963);双染检出CIN2+的特异度(58.54%vs 21.95%,P=0.0014)、总体符合率(65.38%vs 36.54%,P=0.0058)、阳性预测值(37.04%vs 23.81%,P=0.2829)、阴性预测值(96.00%vs 90.00%,P=0.4958)和Kappa系数(0.3227 vs 0.0633)均优于hrHPV检测,可减少28.9%的阴道镜分流。组织学p16/Ki-67双染的阳性率与病变程度大致呈正比。结论细胞学p16/Ki-67双染是一个较好的宫颈癌筛查分流手段,可提高CIN2+检出效能,降低误诊率及过度治疗。组织学p16/Ki-67双染是一组良好的生物学标记物,可辅助宫颈病变的诊断。Objective:To compare the triage and diagnostic efficiency of p16/Ki-67 double-staining and high-risk human papillomavirus(hrHPV)assay in patients with atypical squamous cells of undermined significance(ASCUS).Methods:Collecting the cases with ASCUS of cytological diagnosis,hrHPV test and cervical histopathological result.The remaining cervical epithelial cell samples were analyzed by p16/Ki-67 double staining.The diagnostic efficiency of cytological p16/Ki-67 double staining and hrHPV in cervical intraepithelial neoplasia 2(CIN2)or above was compared.Collecting cervical histological specimens and conducting histological p16/Ki-67 double staining to compare the consistency between the histological p16/Ki-67 double staining and pathology results.Results:The positive rate of cytological p16/Ki-67 was approximately proportional to the degree of lesions,and the consistency was higher than hrHPV detection(P=0.6963).The specificity(58.54%vs 21.95%,P=0.0014),the overall coincidence rate(65.38%vs 36.54%,P=0.0058),the positive predictive value(37.04%vs 23.81%,P=0.2829),the negative predictive value(96.00%vs 90.00%,P=0.4958)and the Kappa coefficient(0.3227 vs 0.0633)of p16/Ki-67 double staining for CIN2+were all better than hrHPV detection,which could reduce 28.9%of colposcopy referral rate.The positive rate of histological p16/Ki-67 double staining was approximately proportional to the degree of lesions.Conclusion:Cytological p16/Ki-67 double staining is a better method for cervical cancer screening triage,which can improve the detection efficiency of CIN2+,reduce the rate of misdiagnosis and overtreatment.Histological p16/Ki-67 double staining is a good biological marker to assist the diagnosis of cervical lesions.

关 键 词：人乳头瘤病毒 宫颈上皮内瘤变 p16/Ki-67双染 

分 类 号：R711.74[医药卫生—妇产科学]