Expression of P16 in high-risk human papillomavirus related lesions of the uterine cervix in a government hospital, Malaysia

Abstract

BackgroundCervical cancer is one of the most common cancers affecting women worldwide. It is well established that human papilloma virus (HPV) infection is the prime risk factor in the development of cervical cancer. The current screening and diagnostic tests have limitations in identifying the range of lesions caused by HPV. The current study aims to evaluate the diagnostic value of p16 immunohistochemical (IHC) investigation in high-risk human papillomavirus (HR-HPV) related lesions of the uterine cervix in Hospital Tuanku Jaafar, Seremban, Malaysia.MethodsA total of 75 cases were selected from the records of Pathology services, Hospital Tuanku Ja’afar, Seremban. The samples were collected in three separate groups (n = 25 per group) as Carcinoma cervix, Carcinoma in situ and Chronic cervicitis. The demographic data of the patients and the representative paraffin blocks were retrieved from Hospital Tuanku Ja’afar, Seremban. The immunohistochemical staining with p16 and HPV 16 L1 were done on all cases. The staining intensity and density were observed and compared among the three groups of cases.ResultsImmunohistochemistry of p16INK4A staining shows nil (0/25) expression in the cervicitis patients, 72% (18/25) in CIN patients and 100% (25/25) in cervical carcinoma. HPV 16 L1 was positive in 100% (25/25) of cervicitis patients, 96% (24/25) of CIN patients and 40% (10/25) of cervical cancers patients. A chi square test was used to analyze the result and the obtained p value was <0.05.Conclusionp16 expression was strongly observed in cervical cancer and minimally observed in cervicitis. Thus indicating p16 immunohistochemistry investigations can aid in diagnosing the different categories of cervical lesions into benign, insitu and malignant.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_202

Human Papillomavirus Genotyping and p16INK4aExpression in Cervical Lesions: A Combined Test to Avoid Cervical Cancer Progression

“…In fact, many reports revealed p16 INK4a overexpression by immunohistochemistry in a very high proportion of neoplasia intraepithelial high grade, 80% to 100% of cervical intraepithelial neoplasia (CIN)2 and almost all CIN3, and in nearly all invasive cervical cancers, with diffuse expression throughout the height of squamous epithelium. 26 – 29 Thus, these data indicate that p16 INK4a protein expression can be used to improve the histopathological diagnosis of precancerous cervical lesions. 30 …”

The role of p16 as putative biomarker for cervical neoplasia: A controversial issue?

“…Several studies have reported p16 overexpression in cervical cancer as well as in high grade cervical intraepithelial neoplasia (CIN2-3), [9][10][11] although the clinical importance of these findings remains controversial. A meta-analysis showed that p16 overexpression in cervical cancer specimens appeared to increase overall or disease-free survival rates, indicating a more favorable prognosis.…”

Application of p16, p63, cyclin D1 immunostaining and nuclear morphometric analysis for assessment of cervical dysplasia

“…From other experimental and literature data and review articles following should be kept in mind, regarding p16 expression: its level can both increase or decrease depending on tissue.There are great variations in interpretation of what p16 positivity is in some studies. Therefore it is important to find panel of biomarkers necessary for the diagnosis of cervical epithelial especially for the differential diagnosis of the degree of dysplasia in cases borderline from LSIL to HSIL (16,20,21,22).Our result show that p16 expression is one of the most significant biomarkers and diagnostic methods for HPV. This was confirmed both in accordance with the fact that p16 can rarely be positive in the cervical epithelium without dysplasia, but in a different percentage and a different microscopic image of the visualization of it.Thats why we have to be very careful with interpretations of this imunohistochemical marker.…”