Differential diagnosis of high-grade squamous intraepithelial lesions and benign atrophy in older women using p16 immunocytochemistry

Yan, Peisha; Du, Hui; Wang, Chun; Song, Fangbin; Huang, Xia; Luo, Yadong; Wu, Ruifang

doi:10.1016/j.gocm.2020.10.005

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…In this study, we found that P16 cytology is advantageous in facilitating cytologists to differentiate benign lesions from LBC-≥HSIL in women ≥50 years of age. Due to obvious decreased levels of estrogen in women during perimenopause, some atrophic cervical cells are usually included in the cervical samples for cytology, resulting in its potential misinterpretation as HSIL ( 11 ). As the atrophic cells have smaller portions of cytoplasm, it is easy to be confused with HSIL cells on Papanicolaou-stained cytology slides, and this has always been challenging to cytologists, especially to the inexperienced ones in lower-resource regions.…”

Section: Discussionmentioning

confidence: 99%

Performance of P16INK4a immunocytochemical stain in facilitating cytology interpretation of HSIL for HPV-positive women aged 50 and above

Hou,

Du,

Wang

et al. 2024

Front. Oncol.

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BackgroundFew 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.ObjectiveTo evaluate the role of P16 cytology in differentiating cytology HSIL from benign atrophy in women aged 50 years and above.MethodsIncluded 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.ResultsOne 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.ConclusionP16 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.

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Section: Discussionmentioning

confidence: 99%

Performance of P16INK4a immunocytochemical stain in facilitating cytology interpretation of HSIL for HPV-positive women aged 50 and above

Hou,

Du,

Wang

et al. 2024

Front. Oncol.

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“…Elderly women have some characteristics that make triage with cytology ineffective and modify the performance of the HPV test: the prevalence of HPV infections decreases with age; thus, in post-menopausal women, the HPV test will have a greater sensitivity and specificity similar to that of cytology but the atrophy of the squamous epithelium makes the Pap test less efficient and has the disadvantage of having a low specificity [17,18]. Some authors have reported a sensitivity of cytology for CIN2+ of 67% but this sensitivity drops to 17% for cases with atrophy [19].…”

Section: Discussionmentioning

confidence: 99%

Performance of p16/Ki67 Immunostaining for Triage of Elderly Women with Atypical Squamous Cells of Undetermined Significance

Bruno

Guaita

Boemi

et al. 2023

JCM

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Background: The p16/Ki67 technique has been poorly studied in postmenopausal women with ASC-US cytology. The objective of this study was to compare the accuracy of p16/Ki67 staining, HPV testing and HPV 16 genotyping for the identification of CIN2 + lesions in postmenopausal women with ASC-US cytology. Method: A total of 324 postmenopausal women with positive ASC-US were included. The women underwent HPV test, colposcopy, and biopsy. The slides were discolored and then stained with the CINtec Plus Kit for p16/Ki67. The HPV test results were classified as HPV16 +, hrHPV+ (other hrHPV genotypes), or HPV negative. Results: The p16/Ki67 sensitivity for CIN2+ was 94.5%, the specificity 86.6%, PPV of 59% and NPV of 95.9%. The HPV test showed a sensitivity of 96.4% for CIN2+, a specificity of 62.8%, a PPV of 35% and a NPV of 98.8%. In postmenopausal women, the prevalence of genotype 16 decreases in favor of the other high-risk genotypes. Conclusion: Given the low sensitivity of cytology and the low percentage of HPV16-positive cancers among elderly women, triage via cytology and genotyping is not the best strategy; double staining cytology shows high profiles of sensibility and specificity for CIN2+ in ASCUS postmenopausal women.

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“…In gynecological pathology (ISSVD) since 2015, squamous intraepithelial lesions of the vulva of three degrees of malignancy: low-grade intraepithelial lesion (LSIL)condylomas, vulvar epithelial neoplasia, usual type, effect of the human papilloma virus; high-grade intraepithelial lesion (HSIL)vulvar intraepithelial neoplasia, usual type; vulvar intraepithelial neoplasia, differentiated type. The most frequent symptom is itching, mainly at night [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The results analysis of cytological examination of vulvar intraepithelial neoplasia compared to histology report

Dunaevskaya¹,

Loginova

Botsuin³

et al. 2022

SR:MS

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Timely diagnosis and effective treatment of precancerous diseases of the female genital organs prevent the development of oncogynecological diseases. Vulvar intraepithelial neoplasia is a precancerous disease characterized by lesions of the stratified squamous epithelium with impaired maturation and normal keratinization of cells, but without inclusion of the basement membrane in the pathological process. The main methods of diagnosis of vulvar intraepithelial neoplasia are vulvoscopy, cytological and histological examination. The aim of this study was to assess the clinical significance and effectiveness of different sampling methods for cytological examination in comparison with histological report. Materials and methods. The study involved 235 women aged 35-79 years, with a mean age of 57±11,3 years with complaints of pain, burning, discomfort and itching in the vulva. All patients underwent a simple vulvoscopy, where atrophy of the mucosa, partial or complete loss of the clitoris and / or labia minora, fissures, ecchymoses (haemorrhages), eroded surfaces, exophytic growths from 1 to 5 cm were detected. Material sampling was performed by various cytological methods. Results. According to the results of the study, no significant differences between the methods of cytological sampling were observed. The cytological report was compared to the result of histological examination of biopsies. According to the results of cytological examination, squamous cell carcinoma of the vulva was detected in 12 patients, atrophy was identified in 5 women and squamous epithelial scales cytologically detected in the remaining 218 women. Conclusions. The sensitivity and specificity of cytological examination methods were high in the presence of eroded surfaces and exophytic lesions. It was found that cytological research methods were not informative enough to detect vulvar cancer, which is in the stratum of hyperkeratosis, and was diagnosed in 5.1 % of patients. Therefore, for the reliability of the results and confirmation of the diagnosis it is necessary to conduct histological examination, with the help of which 14.9 % of patients were diagnosed with squamous cell carcinoma

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Differential diagnosis of high-grade squamous intraepithelial lesions and benign atrophy in older women using p16 immunocytochemistry

Cited by 3 publications

References 25 publications

Performance of P16INK4a immunocytochemical stain in facilitating cytology interpretation of HSIL for HPV-positive women aged 50 and above

Performance of P16INK4a immunocytochemical stain in facilitating cytology interpretation of HSIL for HPV-positive women aged 50 and above

Performance of p16/Ki67 Immunostaining for Triage of Elderly Women with Atypical Squamous Cells of Undetermined Significance

The results analysis of cytological examination of vulvar intraepithelial neoplasia compared to histology report

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