| 李 莉,王 林,李菊晓.宫颈细胞内p16/Ki67表达与宫颈癌及癌前病变的关系及其用于HPV阳性人群分流的诊断价值[J].中国肿瘤,2018,27(4):311-315. |
| 宫颈细胞内p16/Ki67表达与宫颈癌及癌前病变的关系及其用于HPV阳性人群分流的诊断价值 |
| Expression of p16/Ki67 in Cervical Cancer and Precancerous Tissue and its Diagnostic Value for HPV Positive Women |
| 投稿时间：2017-12-19 |
| DOI：10.11735/j.issn.1004-0242.2018.04.A012 |
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| 中文关键词: p16/Ki67双染 HPV E6/E7mRNA检测 LBC检测 宫颈上皮内瘤变 |
| 英文关键词:p16/Ki-67 dual staining HPV E6/E7mRNA LBC CIN |
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| 中文摘要: |
| 摘 要：［目的］ 探讨p16/Ki67双染技术对宫颈癌及癌前病变的检出能力，比较其用于HPV阳性人群分流的诊断价值。［方法］ 选取2016年9月至2017年5月山西长治三家三甲医院21~70岁参加宫颈癌筛查的妇女及门诊患者共计497例，所有入组研究对象均进行HPV E6/E7mRNA检测、液基细胞学检测（LBC）与p16/Ki67双染。［结果］ p16/Ki67双染的阳性率随细胞学诊断及病理诊断的严重程度的增加而升高(P<0.05）；p16/Ki67对62例宫颈上皮内瘤变2级及以上（CIN2+）研究对象检出的灵敏度、特异性分别为69.4%、83.6%，HPV E6/E7mRNA检测分别为82.3%、74.6%，LBC检测分别为80.6%、65.2%。对49例CIN3+研究对象检出的灵敏度、特异性分别为69.4%、81.9%，HPV E6/E7mRNA检测分别为85.7%、73.3%。在CIN2+/CIN3+病例中p16/Ki67的灵敏度与LBC均衡可比，但其特异性明显高于 LBC 和HPV E6/E7mRNA检测。在HPV E6/E7mRNA检测阳性人群中p16/Ki67双染对CIN2+检出的灵敏度和特异性分别为82.4%和56.9%，LBC检测为90.2%和29.4%；p16/Ki67双染对CIN3+检出的灵敏度和特异性分别为81.0%和53.2%，LBC检测为88.1%和27.0%。p16/Ki67双染中对CIN2+及CIN3+检出的灵敏度与LBC检测相比均无明显差异（P>0.05），但其特异性明显高于LBC检测（P<0.001）。［结论］ p16/Ki67双染技术用于HPV阳性人群的分流具有优于LBC的特异性和与LBC检测相似灵敏度的特性。在经济条件允许或者缺乏病理医生的地区，可以考虑使用p16/Ki67代替细胞学用于宫颈癌的初筛或HPV阳性人群的分流。 |
| 英文摘要: |
| Abstract：［Purpose］ To investigate the expression of p16/Ki67 in cervical cancer and precancerous tissues and its diagnostic value for HPV positive women. ［Methods］ A total of 497 women aged 21~70 years were enrolled in this study. The expression of HPV E6/E7mRNA was detected. Liquid based cytology (LBC) was performed and the p16/Ki67 expression was determined by dual staining immunohistochemistry. ［Results］ The positive rate of p16/Ki67 dual stain increased with the increase of cytologic and pathologic categories (P<0.05). For diagnosis of CIN2+，the sensitivity and specificity of p16/Ki67 were 69.4% and 83.6%，those of HPV E6/E7 mRNA were 82.3% and 74.6%，those of the LBC were 80.6% and 65.2%，respectively. For diagnosis of CIN3+，the sensitivity and specificity of p16/Ki67 were 69.4% and 81.9%，those of HPV E6/E7mRNA were 85.7% and 73.3%，those of LBC were 85.75% and 73.3%，respectively. For diagnosis of CIN2+/CIN3+，the sensitivity of p16/Ki67 was equal to LBC，but the specificity of p16/Ki67 dual stain was higher than that of LBC and HPV E6/E7 mRNA (P<0.05). In the HPV positive women the sensitivity and specificity of p16/Ki67 were 82.4% and 56.9%，those of LBC were 90.2% and 29.4%. McNemar test showed that there was no significant difference in sensitivity for diagnosis of CIN2+/CIN3+ between p16/Ki67 and LBC，but the specificity of p16/Ki67 dual staining was higher than that of LBC(P>0.05). ［Conclusion］ In HPV positive women the p16/Ki67 dual stain has a higher specificity than LBC. Therefore p16/Ki67 dual staining can be considered as a screening method for cervical cancer in HPV positive women. |
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