■很少有文章关注高级别鳞状上皮内病变(HSIL)的细胞学误解。由于雌激素缺乏,绝经后妇女的宫颈上皮细胞倾向于显示萎缩性变化,在Papanicolaou染色的细胞学载玻片上看起来像HSIL,导致更高的细胞学误解率。P16INK4a免疫细胞化学染色(P16细胞学)可以有效区分病变细胞与正常萎缩性细胞,对细胞形态的依赖性较小。
■评估P16细胞学在50岁及以上女性细胞学HSIL与良性萎缩的鉴别中的作用。
■这项分析包括在中国中部进行的宫颈癌筛查项目中的妇女,这些妇女的高危型人乳头瘤病毒(hr-HPV)检测呈阳性,并返回以完整的数据进行分诊液基细胞学(LBC)分析,P16免疫染色细胞学解释,和病理诊断。纳入的患者按年龄分组:≥50(1,127例)和<50岁(1,430例)。比较两组LBC和P16细胞学检测病理≥HSIL的准确性,进一步分析了P16免疫染色在鉴别宫颈良性病变和细胞学≥HSIL中的作用。
■≥50组中有一百六十七名女性(14.8%;167/1,127)和255(17.8%,<50组255/1,430)病理诊断为HSIL(Path-HSIL)。LBC[≥意义不明的非典型鳞状细胞(ASCUS)]和P16细胞学(阳性)在<50组中分别检测到63.9%(163/255)和90.2%(230/255)的Path-≥HSIL病例,在≥50组中分别检测到74.3%(124/167)和93.4%(124/167)。在<50组中255例Path-≥HSIL病例中有105例(41.2%)LBC与病理匹配,在≥50组中167例Path-≥HSIL病例中有93例(55.7%)。<50组中有5例,≥50组中有14例,是Path-≤LSIL病例,被LBC解释为HSIL,但P16细胞学检查阴性.
■P16细胞学检查有助于50岁及以上女性的LBC-≥HSIL与Path-≤LSIL的鉴别。它可以用于资源较低的地区,在合格的细胞学专家不足的地方,作为≥50岁女性的二次筛查测试,以避免不必要的活检和对LBC初次或二次筛查的误解。
UNASSIGNED: Few articles have focused on the cytological misinterpretation of high-grade squamous intraepithelial lesion (HSIL). Due to estrogen deficiency, cervical epithelial cells in postmenopausal women tend to show atrophic change that looks like HSIL on Papanicolaou-stained cytology slides, resulting in a higher rate of cytological misinterpretation. P16INK4a immunocytochemical staining (P16 cytology) can effectively differentiate diseased cells from normal atrophic ones with less dependence on cell morphology.
UNASSIGNED: To evaluate the role of P16 cytology in differentiating cytology HSIL from benign atrophy in women aged 50 years and above.
UNASSIGNED: Included in this analysis were women in a cervical cancer screening project conducted in central
China who tested positive for high-risk human papillomavirus (hr-HPV) and returned back for triage with complete data of primary HPV testing, liquid-based cytology (LBC) analysis, P16 immuno-stained cytology interpretation, and pathology diagnosis. The included patients were grouped by age: ≥50 (1,127 cases) and <50 years (1,430 cases). The accuracy of LBC and P16 cytology in the detection of pathology ≥HSIL was compared between the two groups, and the role of P16 immuno-stain in differentiating benign cervical lesions from cytology ≥HSIL was further analyzed.
UNASSIGNED: One hundred sixty-seven women (14.8%; 167/1,127) in the ≥50 group and 255 (17.8%, 255/1,430) in the <50 group were pathologically diagnosed as HSIL (Path-HSIL). LBC [≥Atypical Squamous Cell Of Undetermined Significance (ASCUS)] and P16 cytology (positive) respectively detected 63.9% (163/255) and 90.2% (230/255) of the Path-≥HSIL cases in the <50 group and 74.3% (124/167) and 93.4% (124/167) of the Path-≥HSIL cases in the ≥50 group. LBC matched with pathology in 105 (41.2%) of the 255 Path-≥HSIL cases in the <50 group and 93 (55.7%) of the 167 Path-≥HSIL cases in the ≥50 group. There were five in the <50 group and 14 in the ≥50 group that were Path-≤LSIL cases, which were interpreted by LBC as HSIL, but negative in P16 cytology.
UNASSIGNED: P16 cytology facilitates differentiation of Path-≤LSIL from LBC-≥HSIL for women 50 years of age and above. It can be used in the lower-resource areas, where qualified cytologists are insufficient, as the secondary screening test for women aged ≥50 to avoid unnecessary biopsies and misinterpretation of LBC primary or secondary screening.