p16/Ki-67 Dual-Stained Cytology Testing May Predict Postpartum Outcome in Patients with Abnormal Papanicolaou Cytology during Pregnancy

Abstract

Objective: To evaluate the use of a new immunocytochemical dual-staining protocol, which allows for the detection of coexpression of the p16^INK4a (p16) and Ki-67 biomarkers in prenatal care. It was hypothesized that dual-staining cytology may predict postpartum outcome in patients with abnormal cervical Papanicolaou (Pap) smears during pregnancy. Study Design: In this retrospective pilot study, 27 abnormal Pap smears collected from women during early pregnancy were destained and subsequently stained for p16/Ki-67. Results were correlated with histologic outcome collected during postpartum follow-up. Results: Fourteen of 20 abnormal Pap smears during pregnancy showed a positive p16/Ki-67 dual-stained cytology result, whereas 6 specimens tested negative. Seven cases were excluded due to technical reasons. All 14 patients who were positive for p16/Ki-67 dual stain had cervical intraepithelial neoplasia (CIN) on postpartum histology. In contrast, 5 out of 6 patients negative for p16/Ki-67 dual-staining had a negative histology postpartum and during follow-up, and the remaining patient showed a CIN1 (p < 0.001). Conclusion: p16/Ki-67 dual-stained cytology may provide a valuable novel approach to identify pregnant women with persistent or progressing CIN disease and may help improve the management of abnormal Pap cytology results during pregnancy.

Difficulty of cervical cancer diagnosis during pregnancy: A case series analysis of the clinicopathological characteristics and prognosis of cervical cancer diagnosed during pregnancy or within 6 months after parturition

“…In addition, colposcopic examination is difficult, and the diagnosis of 'atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion' was found to be less predictive of underlying high-grade squamous intraepithelial lesions in pregnant women compared with the general population (19). On the other hand, p16/Ki-67 dual-staining cytology may provide a valuable and novel approach to identify persistent or progressive CIN in pregnant women, and it may improve the management of abnormal Papanicolaou cytology results during pregnancy (20). Cytological specimens were collected using cotton-tipped applicators, and neither HPV typing nor p16 immunocytochemistry was performed for cytological diagnosis in this study.…”

Atrophic Pap Smears, Differential Diagnosis and Pitfalls: A Review

“…Although the application of the above mentioned cytologic criteria will be useful in most of these difficult cases, some investigators recommended that utilization of immunocytologic markers such as Ki67 would be effective in some of the problematic cases (20,21). Other studies proposed that immunocytochemical detection of P16 and ki67 acts as a more accurate route in establishing a correct diagnosis (22)(23)(24).…”

Non-invasive cervical cancer during pregnancy. Prognosis for mothers and children

“…Чувствительность и специфичность метода были продемонстрированы на основании многоцентровых исследований, однако масштабных исследований по эффективности и применению метода у беременных не представлено. Лишь G. Trutnovsky в 2014 г. в Медицинском университете г. Грац (Австрия) провел ретроспективное экспериментальное иммуноцитохимическое исследование среди беременных женщин с CIN [14] Г и н е к о л о г и я / G y n e c o l o g y поражение низкой степени -low grade squamous intraepithelial lesion, LSIL) (95 % доверительный интервал (ДИ) 1,465-65,400). В настоящей работе также установлена зависимость биологического поведения заболевания от возраста женщин.…”