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Jeromel S, Repše Fokter A, Dovnik A. P16/Ki67 Dual Staining in Glandular Cell Abnormalities of the Uterine Cervix. Cancers (Basel) 2024; 16:1621. [PMID: 38730573 PMCID: PMC11083027 DOI: 10.3390/cancers16091621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/14/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
Very limited information exists about the role of p16/Ki67 dual staining on glandular cells in detecting glandular precancerous lesions and cervical adenocarcinoma. In this study, we investigated the diagnostic accuracy of p16/Ki67 dual staining for the detection of glandular and squamous lesions on the uterine cervix and for cancer of the upper reproductive tract. We performed a retrospective analysis of prospectively collected data on 96 patients with glandular cell abnormalities. We analyzed the diagnostic accuracy of p16/Ki67 dual staining for atypical glandular cells, not otherwise specified (AGC-NOS); atypical glandular cells, favor neoplastic (AGC-FN); adenocarcinoma in situ (AIS); and A-CA (cervical adenocarcinoma). A separate analysis for the detection of squamous precancerous lesions and squamous-cell carcinoma (CIN3+) and for cancer of the upper reproductive tract (EC/OC) was performed. Among patients who had normal histology or a low-grade lesion on final analysis, only 8.5% had positive dual staining. On the other hand, 85.7% of patients with AIS+ on final histology had positive dual staining. The respective specificities of p16/Ki67 dual staining on AGC-NOS for the detection of AIS+ (adenocarcinoma in situ or cervical adenocarcinoma), CIN3+ and EC/OC were 91.5%, 88.7% and 86.4%. High specificity values of p16/Ki67 dual staining on cervical smears labelled as AGC-NOS for the detection of CIN3+ and AIS+ suggest that this method might be a useful addition in cervical cancer screening.
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Affiliation(s)
- Saša Jeromel
- Medical Faculty, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia;
| | - Alenka Repše Fokter
- Department of Pathology and Cytology, General Hospital Celje, Oblakova 5, 3000 Celje, Slovenia
| | - Andraž Dovnik
- Medical Faculty, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia;
- University Clinic for Gynaecology and Obstetrics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
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2
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Ryu A, Honma K, Shingetsu A, Tanada S, Yamamoto T, Nagata S, Kamiura S, Yamasaki T, Ohue M, Matsuura N. Utility of p16/Ki67 double immunocytochemistry for detection of cervical adenocarcinoma. Cancer Cytopathol 2022; 130:983-992. [PMID: 35976043 DOI: 10.1002/cncy.22631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Although the incidence of cervical adenocarcinoma has consistently increased, especially among young women, there is no established best means for screening. This study evaluated the screening efficacy of CINtec PLUS (CINtec; p16/Ki67 double immunocytochemistry) expression in cervical glandular cells. METHODS Cervical cytology was examined using abnormal glandular cells. The CINtec status of 100 samples with corresponding surgically resected specimens and 11 samples that exhibited negative results for intraepithelial lesion or malignancy at follow-up was analyzed. Additionally, 31 negative samples containing benign glandular cells were included. RESULTS Of the 142 samples, CINtec status was diffusely positive in 74, focally positive in 24, and negative in 44. The 74 diffusely positive samples included 70 adenocarcinomas (62 cervical, seven uterine, and one ovarian) and four cases of high-grade cervical intraepithelial neoplasia. The 24 focally positive samples included 15 adenocarcinomas (seven cervical, seven uterine, and one fallopian tube) and nine without malignancy. The 44 negative samples included nine adenocarcinomas (five uterine and four cervical) and 35 without malignancy. The sensitivity, specificity, positive predictive value, and negative predictive value of the CINtec diffusely or focally positive cases for cervical adenocarcinomas were 94.5%, 58.0%, 70.4%, and 90.9%, respectively. In CINtec diffusely positive cases, the respective values were 84.9%, 82.6%, 83.8%, and 83.8%, and in women aged ≤39 years the values were 90.6%, 89.5%, 93.5%, and 85.0%, respectively. CONCLUSIONS CINtec may support efficient detection of cervical adenocarcinomas.
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Affiliation(s)
- Ayumi Ryu
- Department of Oncology, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan.,Departments of Clinical Laboratory, Osaka International Cancer Institute, Osaka City, Osaka, Japan.,Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Keiichiro Honma
- Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Azusa Shingetsu
- Departments of Clinical Laboratory, Osaka International Cancer Institute, Osaka City, Osaka, Japan.,Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Satoshi Tanada
- Departments of Clinical Laboratory, Osaka International Cancer Institute, Osaka City, Osaka, Japan.,Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Takashi Yamamoto
- Departments of Clinical Laboratory, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Shigenori Nagata
- Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Shoji Kamiura
- Gynecologic Oncology, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Tomoyuki Yamasaki
- Departments of Clinical Laboratory, Osaka International Cancer Institute, Osaka City, Osaka, Japan
| | - Masayuki Ohue
- Department of Oncology, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
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Secosan C, Balint O, Ilian A, Balan L, Balulescu L, Motoc A, Zahoi D, Grigoras D, Pirtea L. New Insights in the Diagnosis of Rare Adenocarcinoma Variants of the Cervix—Case Report and Review of Literature. Healthcare (Basel) 2022; 10:healthcare10081410. [PMID: 36011067 PMCID: PMC9408547 DOI: 10.3390/healthcare10081410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
We report the case of a 29-year-old patient with low-grade squamous intraepithelial lesion (L-SIL), negative human papilloma virus (HPV), positive p16/Ki-67 dual-staining and colposcopy suggestive for severe dysplastic lesion. The patient underwent a loop electrosurgical excision procedure (LEEP), the pathology report revealing mesonephric hyperplasia and adenocarcinoma. The patient also opted for non-standard fertility-sparing treatment. The trachelectomy pathology report described a zone of hyperplasia at the limit of resection towards the uterine isthmus. Two supplementary interpretations of the slides and immunohistochemistry (IHC) were performed. The results supported the diagnosis of mesonephric adenocarcinoma, although with difficulty in differentiating it from mesonephric hyperplasia. Given the discordant pathology results that were inconclusive in establishing a precise diagnosis of the lesion and the state of the limits of resection, the patient was referred to a specialist abroad. Furthermore, the additional interpretation of the slides and IHC were performed, the results suggesting a clear cell carcinoma. The positive p16/Ki-67 dual-staining prior to LEEP, the non-specific IHC and the difficulties in establishing a diagnosis made the case interesting. Given the limitations of cytology and the fact that these variants are independent of HPV infection, dual staining p16/Ki-67 could potentially become useful in the diagnosis of rare adenocarcinoma variants of the cervix, however further documentation is required.
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Affiliation(s)
- Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
| | - Oana Balint
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
- Correspondence: ; Tel.: +40-740-282-844
| | - Aurora Ilian
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
| | - Lavinia Balan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
| | - Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
| | - Andrei Motoc
- Department of Anatomy and Embryology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.); (D.Z.)
| | - Delia Zahoi
- Department of Anatomy and Embryology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.M.); (D.Z.)
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania; (C.S.); (A.I.); (L.B.); (L.B.); (D.G.); (L.P.)
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4
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Karunakaran V, Saritha VN, Ramya AN, Murali VP, Raghu KG, Sujathan K, Maiti KK. Elucidating Raman Image-Guided Differential Recognition of Clinically Confirmed Grades of Cervical Exfoliated Cells by Dual Biomarker-Appended SERS-Tag. Anal Chem 2021; 93:11140-11150. [PMID: 34348462 DOI: 10.1021/acs.analchem.1c01607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ultrasensitive detection of cancer biomarkers via single-cell analysis through Raman imaging is an impending approach that modulates the possibility of early diagnosis. Cervical cancer is one such type that can be monitored for a sufficiently long period toward invasive cancer phenotype. Herein, we report a surface-enhanced Raman scattering (SERS) nanotag (SERS-tag) for the simultaneous detection of p16/K-i67, a dual biomarker persisting in the progression of squamous cell carcinoma of human cervix. A nanoflower-shaped SERS-tag, constituted of hybrid gold nanostar with silver tips to achieve maximum fingerprint enhancement from the incorporated reporter molecule, was further functionalized with the cocktail monoclonal antibodies against p16/K-i67. The recognition by the SERS-tag was first validated in cervical squamous cell carcinoma cell line SiHa as a foot-step study and subsequently implemented to different grades of clinically confirmed exfoliated cells including normal cell (NC), high-grade intra-epithelial lesion (HC), and squamous cell carcinoma (CC) samples of the cervix. Precise Raman mapped images were constituted based on the average intensity gradient of the signature Raman peaks arising from different grades of exfoliated cells. We observed a distinct intensity hike of around 10-fold in the single dysplastic HC and CC samples in comparison to NC specimen, which clearly justify the prevalence of p16/Ki-67. The synthesized probe is able to map the abnormal cells within 20 min with high reproducibility and stability for 1 mm × 1 mm mapping area with good contrast. Amidst the challenges in Raman image-guided modality, the technique was further complemented with the gold standard immunocytochemistry (ICC) dual staining analysis. Even though both are time-consuming techniques, tedious steps can be avoided and real-time readout can be achieved using the SERS mapping unlike immunocytochemistry technique. Therefore, the newly developed Raman image-guided SERS imaging emphasizes the approach of uplifting of SERS in practical utility with further improvement for clinical applications for cervical cancer detection in future.
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Affiliation(s)
- Varsha Karunakaran
- CSIR-National Institute for Interdisciplinary Science & Technology (NIIST), Chemical Sciences & Technology Division (CSTD), Organic Chemistry Section, Thiruvananthapuram 695019, Kerala, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Valliamma N Saritha
- Regional Cancer Centre (RCC), Division of Cancer Research, Thiruvananthapuram 695011, Kerala, India
| | - Adukkadan N Ramya
- CSIR-National Institute for Interdisciplinary Science & Technology (NIIST), Chemical Sciences & Technology Division (CSTD), Organic Chemistry Section, Thiruvananthapuram 695019, Kerala, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Vishnu Priya Murali
- CSIR-National Institute for Interdisciplinary Science & Technology (NIIST), Chemical Sciences & Technology Division (CSTD), Organic Chemistry Section, Thiruvananthapuram 695019, Kerala, India
| | - Kozhiparambil G Raghu
- CSIR-National Institute for Interdisciplinary Science & Technology (NIIST), Agro-Processing and Technology Division (APTD), Thiruvananthapuram 695019, Kerala, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Kunjuraman Sujathan
- Regional Cancer Centre (RCC), Division of Cancer Research, Thiruvananthapuram 695011, Kerala, India
| | - Kaustabh Kumar Maiti
- CSIR-National Institute for Interdisciplinary Science & Technology (NIIST), Chemical Sciences & Technology Division (CSTD), Organic Chemistry Section, Thiruvananthapuram 695019, Kerala, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
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5
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Yu L, Fei L, Liu X, Pi X, Wang L, Chen S. Application of p16/Ki-67 dual-staining cytology in cervical cancers. J Cancer 2019; 10:2654-2660. [PMID: 31258773 PMCID: PMC6584925 DOI: 10.7150/jca.32743] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/07/2019] [Indexed: 12/19/2022] Open
Abstract
Cytology-based Papanicolaou test on and primary HPV screening have been widely used in the identification of cervical cancer and precancerous lesions, which is of great significance for the prevention and treatment of cervical cancer. Patients diagnosed as ASCUS/LSIL usually need follow-up because some of them may develop into CIN2+. The consequences of women positive for HPV vary from person to person; some of them may progress into cervical dysplasia, reversible forms of precancerous lesions, and eventually invasive cervical cancer. Therefore, it is necessary to establish an effective biomarker to triage different patients according to the preliminary screening results. p16 acts as a cell cycle regulatory protein that induces cell cycle arrest, and Ki-67 is a cell proliferation marker. Under physiological conditions, they could not co-express in the same cervical epithelial cells. The co-expression of these two molecules suggests a deregulation of the cell cycle mediated by HR-HPV infection and predicts the presence of high-grade cervical epithelial lesions. There is increasing evidence that p16/Ki-67 dual-staining cytology can be used as an alternative biomarker, showing overall high sensitivity and specificity for identifying high-grade CIN and cervical cancer. In this review, we discuss the significance of p16/Ki-67 dual-staining and summarize its application in the screening and triaging of cervical cancer and precancerous lesions.
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Affiliation(s)
- Li Yu
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Lingyan Fei
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Xubin Liu
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Xufang Pi
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Liantang Wang
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Shangwu Chen
- State Key Laboratory for Biocontrol, Guangdong Key Laboratory of Pharmaceutical Functional Genes, Key Laboratory of Gene Engineering of the Ministry of Education, Department of Biochemistry, School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, People's Republic of China
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6
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Paper-based immunosensor with signal amplification by enzyme-labeled anti-p16 INK4a multifunctionalized gold nanoparticles for cervical cancer screening. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:1051-1058. [PMID: 29407199 DOI: 10.1016/j.nano.2018.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 11/23/2022]
Abstract
The aim of this study was to develop a paper-based immunosensor for cervical cancer screening, with signal amplification by multifunctionalized gold nanoparticles (AuNPs). The AuNPs were functionalized with a highly specific antibody to the p16INK4a cancer biomarker. The signal was amplified using a combination of the peroxidase activity of horseradish peroxidase (HRP) enzyme-antibody conjugate and the peroxidase-like activity of the AuNPs. The immune complex of p16INK4a protein and multifunctionalized AuNPs was deposited on the nitrocellulose membrane, and a positive result was generated by catalytic oxidation of peroxidase enzyme substrate 3,3',5,5'-Tetramethylbenzidine (TMB). The entire reaction occurred on the membrane within 30 min. Evaluation in clinical samples revealed 85.2% accuracy with a kappa coefficient of 0.69. This proof of concept study demonstrates the successful development of a highly accurate, paper-based immunosensor that is easy to interpret using the naked eye and that is suitable for cervical cancer screening in low-resource settings.
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7
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Wang HR, Li YC, Guo HQ, Yu LL, Wu Z, Yin J, Liao GD, Qu YM, Jiang Y, Wang D, Chen W. A cocktail of p16 INK4a and Ki-67, p16 INK4a and minichromosome maintenance protein 2 as triage tests for human papillomavirus primary cervical cancer screening. Oncotarget 2017; 8:83890-83899. [PMID: 29137390 PMCID: PMC5663562 DOI: 10.18632/oncotarget.19870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 07/11/2017] [Indexed: 02/07/2023] Open
Abstract
Most human papillomavirus (HPV) infections are transient and additional triage approaches should be built after HPV-based primary cervical cancer screening. We evaluated the accuracy of p16/Ki-67 and p16/mcm2 dual staining as biomarkers for triaging HPV positive women in China. 4070 participants aged 35 to 64 years attending ongoing cervical cancer screening were enrolled in 2015-2016. Cervical exfoliated cells were collected for HPV DNA analysis and the residual positive specimens were tested for liquid-based cytology and biomarkers. Women infected with HPV 16/18 type or other 12 high-risk HPV types with abnormal cytology results received colposcopy. We found the positive rates of both biomarkers increased significantly with histology severity. p16/Ki-67 positivity in HPV16/18 group, other 12 high-risk HPV group and HPV negative group was 50.0%, 33.7% and 8.9%, respectively. The corresponding p16/mcm2 positivity was 70.0%, 56.3% and 6.7%, respectively. The sensitivity and specificity of p16/Ki-67 for CIN2+ in all HPV-positive women were 91.7% and 63.5%, with a referral rate of 36.2%, while p16/mcm2 were 87.5% and 42.1%, with a referral rate of 58.4%, respectively. The sensitivity of p16/Ki-67 increased to 95.8% for CIN2+ and 100% for CIN3+ when combined with high-grade cytology, without decrease in specificity. Our studies suggest that p16/Ki-67 is an efficient triaging biomarker for HPV-positive women and could reduce colposcopy workload. p16/mcm2 is more sensitive compared with cytology for identifying cervical lesions.
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Affiliation(s)
- Hai-Rui Wang
- Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yu-Cong Li
- Department of Gynecological Oncology, Chongqing Cancer Institute & Hospital & Cancer Center, Chongqing, PR China
| | - Hui-Qin Guo
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Lu-Lu Yu
- Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Zeni Wu
- Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Jian Yin
- Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Guang-Dong Liao
- Department of Gynecology and Obstetrics, The West China Second University Hospital, Sichuan University, Chengdu, PR China
| | - Yi-Min Qu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yu Jiang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Dong Wang
- Department of Gynecological Oncology, Chongqing Cancer Institute & Hospital & Cancer Center, Chongqing, PR China
| | - Wen Chen
- Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
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Vargas-Hernández VM, Vargas-Aguilar VM, Tovar-Rodríguez JM. [Primary cervical cancer screening]. CIR CIR 2015; 83:448-53. [PMID: 26162490 DOI: 10.1016/j.circir.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 09/04/2014] [Indexed: 11/27/2022]
Abstract
Cervico-uterine cancer screening with cytology decrease incidence by more than 50%. The cause of this cancer is the human papilloma virus high risk, and requires a sensitive test to provide sufficient sensitivity and specificity for early detection and greater interval period when the results are negative. The test of the human papilloma virus high risk, is effective and safe because of its excellent sensitivity, negative predictive value and optimal reproducibility, especially when combined with liquid-based cytology or biomarkers with viral load, with higher sensitivity and specificity, by reducing false positives for the detection of cervical intraepithelial neoplasia grade 2 or greater injury, with excellent clinical benefits to cervical cancer screening and related infection of human papilloma virus diseases, is currently the best test for early detection infection of human papillomavirus and the risk of carcinogenesis.
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Bergeron C, Ikenberg H, Sideri M, Denton K, Bogers J, Schmidt D, Alameda F, Keller T, Rehm S, Ridder R. Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results. Cancer Cytopathol 2015; 123:373-81. [PMID: 25891096 DOI: 10.1002/cncy.21542] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Testing for the presence of the human papillomavirus (HPV) is widely accepted for triaging Papanicolaou cytology results categorized as atypical squamous cells of undetermined significance (ASC-US). In contrast, HPV testing has limited use in triaging cytological low-grade squamous intraepithelial lesions (LSILs) due to prevalence rates of typically >80%. In the current study, the authors assessed the diagnostic performance of p16/Ki-67 dual-stained cytology in triaging ASC-US and LSIL cases within the prospective, multicentric Primary ASC-US LSIL Marker Study (PALMS). METHODS A total of 575 ASC-US cases and 529 LSIL cases from a cohort of 27,349 women who were prospectively enrolled into the PALMS study in 5 European countries were tested with p16/Ki-67 dual-stained cytology and Hybrid Capture 2 (HC2) HPV testing. Colposcopy-guided biopsy results of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were used as clinical endpoints. RESULTS p16/Ki-67 dual-stained cytology demonstrated comparable (ASC-US: 94.4% for dual-stained cytology vs 100% for HC2 testing; P = .317) or lower (LSIL: 85.7% for dual-stained cytology vs 98.4% for HC2 testing; P = .005) sensitivity for CIN2+, but higher levels of specificity compared with HC2 HPV testing in both ASC-US (78.7% vs 60.4%; P<.001) and LSIL (53.3% vs 15.6%; P<.001) cases. Positive predictive values for CIN2+ were substantially higher for dual-stained cytology versus HC2 HPV testing, especially in LSIL, and in ASC-US cases for women aged <30 years. CONCLUSIONS The clinical usefulness and efficiency of triaging women with ASC-US or LSIL Papanicolaou cytology results by p16/Ki-67 dual-stained cytology testing has been confirmed in this prospective, pan-European study. The high positive predictive value of dual-stained cytology for the presence of high-grade CIN may help to reduce the number of unnecessary colposcopy referrals.
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Affiliation(s)
| | | | | | - Karin Denton
- North Bristol NHS Trust, Bristol, United Kingdom
| | - Johannes Bogers
- Algemeen Medisch Laboratorium BVBA, Sonic Healthcare, Antwerp, Belgium
| | | | - Francisco Alameda
- Department of Pathology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Ruediger Ridder
- Roche mtm laboratories, Mannheim, Germany.,Ventana Medical Systems Inc, Tucson, Arizona
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10
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Li S, Tian D, Li Y. Cytological Diagnoses of Adenocarcinoma in situ of the Cervix: Common Misdiagnoses. Acta Cytol 2015; 59:91-96. [PMID: 25766846 DOI: 10.1159/000375360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/19/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In routine screening, glandular lesions have high false-negative and false-positive rates. Our study sought to improve the cytological diagnoses and differentiation of glandular lesions. STUDY DESIGN A total of 24 cytology slides were retrospectively reviewed. Among these slides, 15 were confirmed via histology to have varying amounts of adenocarcinoma in situ (AIS) components. The other 9 cytology slides exhibited AIS mimics that had been originally considered to be AIS or atypical glandular cells (AGCs) and were selected for differentiation from AIS. RESULTS Overall, 12 of the 15 cytological slides exhibited significant atypical glandular features that met the criteria for AIS. However, the original cytological diagnoses included 2 cases of AIS, 3 AGCs-favor neoplasia (AGC-FN), 2 AGCs, 1 case that was not otherwise specified (AGC-NOS), 1 NILM (negative for intraepithelial lesion and malignancy), 3 HSILs (high-grade squamous intraepithelial lesions), and 2 ASC-Hs (atypical squamous cells, cannot exclude HSIL). The latter 9 cytological slides were subsequently histologically confirmed to be 2 metaplasias, 2 reactive lesions, 1 decidual change, 3 serous adenocarcinomas, and 1 SCNEC (small-cell neuroendocrine carcinoma). CONCLUSION Cytological screening will be valuable for identifying glandular lesions as effectively as squamous lesions if the doubly high false rates can be decreased.
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11
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Ancillary Diagnostics in Gynecologic Cytology. Surg Pathol Clin 2014; 7:89-103. [PMID: 26839271 DOI: 10.1016/j.path.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cytology has been the mainstay of cervical dysplasia and cancer screening in the United States. The specificity of a woman harboring a high-grade lesion when identified as high-grade squamous intraepithelial lesion on Pap test is high; however, the test suffers from low sensitivity. Epidemiology studies have demonstrated that human papillomavirus (HPV) types 16 and 18 account for most cervical squamous cell carcinomas. Tests have been developed to identify high-risk HPV, some specifically to identify HPV 16 and 18. Simultaneous to the increase in HPV detection methods, interdisciplinary groups are making recommendations on the managerial use of the tests.
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12
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Tambouret R. Female genital tract. Cancer Treat Res 2014; 160:241-272. [PMID: 24092373 DOI: 10.1007/978-3-642-38850-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rosemary Tambouret
- Department of Pathology, Massachusetts General Hospital, Warren 105/55 Fruit Street, Boston, MA, 02114, USA,
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Ikenberg H, Bergeron C, Schmidt D, Griesser H, Alameda F, Angeloni C, Bogers J, Dachez R, Denton K, Hariri J, Keller T, von Knebel Doeberitz M, Neumann HH, Puig-Tintore LM, Sideri M, Rehm S, Ridder R. Screening for cervical cancer precursors with p16/Ki-67 dual-stained cytology: results of the PALMS study. J Natl Cancer Inst 2013; 105:1550-7. [PMID: 24096620 PMCID: PMC3814411 DOI: 10.1093/jnci/djt235] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Pap cytology is known to be more specific but less sensitive than testing for human papillomavirus (HPV) for the detection of high-grade cervical intraepithelial neoplasia (CIN2+). We assessed whether p16/Ki-67 dual-stained cytology, a biomarker combination indicative of transforming HPV infections, can provide high sensitivity for CIN2+ in screening while maintaining high specificity. Results were compared with Pap cytology and HPV testing. Methods A total of 27349 women 18 years or older attending routine cervical cancer screening were prospectively enrolled in five European countries. Pap cytology, p16/Ki-67 immunostaining, and HPV testing were performed on all women. Positive test results triggered colposcopy referral, except for women younger than 30 years with only positive HPV test results. Presence of CIN2+ on adjudicated histology was used as the reference standard. Two-sided bias-corrected McNemar P values were determined. Results The p16/Ki-67 dual-stained cytology positivity rates were comparable with the prevalence of abnormal Pap cytology results and less than 50% of the positivity rates observed for HPV testing. In women of all ages, dual-stained cytology was more sensitive than Pap cytology (86.7% vs 68.5%; P < .001) for detecting CIN2+, with comparable specificity (95.2% vs 95.4%; P = .15). The relative performance of the tests was similar in both groups of women: younger than age 30 and 30 years or older. HPV testing in women 30 years or older was more sensitive than dual-stained cytology (93.3% vs 84.7%; P = .03) but less specific (93.0% vs 96.2%; P < .001). Conclusions The p16/Ki-67 dual-stained cytology combines superior sensitivity and noninferior specificity over Pap cytology for detecting CIN2+. It suggests a potential role of dual-stained cytology in screening, especially in younger women where HPV testing has its limitations.
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Affiliation(s)
- Hans Ikenberg
- Affiliations of authors: Cytomol, Frankfurt, Germany (HI); Laboratoire Cerba, Cergy Pontoise, France (CB); Institute for Pathology, Mannheim, Germany (DS); Center for Pathology and Cytodiagnostics, Cologne, Germany (HG); Hospital del Mar, Barcelona, Spain (FA); Unità Gestionale Screening Regionale, Ospedale Atri, Italy (CA); Labo Lokeren - Campus Riatol, Antwerp, Belgium (JB); Institute Alfred Fournier, Paris, France (RD); North Bristol NHS Trust, Bristol, United Kingdom (KD); Sønderborg Hospital, Sønderborg, Denmark (JH); Acomed statistik, Leipzig, Germany (TK); Institute for Pathology, University of Heidelberg, Heidelberg, Germany (MvkD); Institute for Pathology, Nordhorn, Germany (HHN); University of Barcelona, Barcelona, Spain (LMP-T); European Institute of Oncology, Milan, Italy (MS); Roche mtm laboratories, Mannheim, Germany (SR, RR)
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