P16(INK4a) immunocytochemistry in liquid-based cytology samples in equivocalPap smears: added value in management of women with equivocal Pap smear
OBJECTIVE: To test whether p1l6(INK4a) immunocytochemistry (ICC) inliquid-based cytology (LBC) is useful with colposcopy in abnormal Pap smears. STUDY DESIGN: A seriesof 248 women with abnormal Pap smear were analyzed for oncogenic (HR) human papillomavirus (HPV)types using the Hybrid Capture II assay and for p16(INK4a) expression using ICC on cervical samplesin PreservCyt liquid media. Colposcopic and loop electrosurgical excision procedure (LEEP) conebiopsy were the gold standard. RESULTS: p16(INK4a) ICC did best as predictor of high-grade squamousintraepithelial lesion, with OR 12.18 (2.72-54.57) (p = 0.0001), showing 88.2% sensitivity (SE),61.9% specificity (SP), 14.6% positive predictive value (PPV) and 98.6% negative predictive value(NPV). In sorting discrepant cases, p16(INK4a) ICC results in 100% SE and 100% NPV in detectingcervical intraepithelial neoplasia (CIN) 2 lesions among Pap+/biopsy- women. In atypical squamouscells undetermined significance (ASCUS) cytology, adding p16(INK4a) ICC improves specificity ofcolposcopy from 27.3% to 81.8% and PPV from 42.8% to 71.4%. Best performance is obtained withp16(INK4a) ICC and colposcopy: 83.3% SE, 81.8% SP, 71.4% PPV and 90.0% NPV. CONCLUSION p16(INK4a) isuseful in sorting clinically relevant discrepant cases, and p16(INK4a) ICC significantly improvesSP and PPV of colposcopy in management of ASCUS cytology.
Monsonego,J　Pollini,G　Evrard,MJ　Sednaoui,P　Monfort,L　Quinzat,D　Dachez,R　Syrjanen,K
Alfred Fournier Institute, Paris, France. jm@eurogin.com
Adolescent　 Adult　 Aged　 Biopsy　 Cervical Intraepithelial Neoplasia CervixUteri
