摘要
目的探讨高危型人乳头瘤病毒(HR-HPV)感染及免疫组化p16、ki67在宫颈腺癌及原位腺癌诊断中的价值。方法选取2016年1月至2017年12月在绍兴市妇幼保健院诊断的宫颈腺上皮病变82例,其中原位腺癌(AIS)18例、浸润性腺癌(ICA)23例、良性腺上皮病变(BEG)41例,分析其中HR-HPV分型和免疫组化p16、ki67的表达特点。结果①ICA及AIS中HR-HPV阳性率为85.37%(35/41),其中HPV16/18型占94.28%(33/35);BEG中HR-HPV阳性率为36.59%(15/41),其中HPV16/18型占66.67%(10/15),差异有统计学意义(χ~2值分别为20.50、6.65,均P<0.05)。②ICA与AIS的比较中,单一感染HPV16型分别为27.27%(3/11)和72.73%(8/11),与单一感染HPV18型[66.67%(10/15)、33.33%(5/15)]比较,差异有统计学意义(χ~2=3.94,P<0.05)。③p16联合ki67在ICA及AIS中的诊断敏感性、特异性、阳性预测值、阴性预测值分别为94.12%、97.37%、96.97%、94.87%。④35例HR-HPV阳性的ICA及AIS病例均显示p16阳性,6例呈HR-HPV阴性的ICA病例p16均阴性。35例HR-HPV阳性ICA及AIS中33例HPV16/18及p16阳性(94.29%),15例HR-HPV阳性BEG中2例HPV16/18及p16阳性(13.33%),两者比较差异有统计学意义(χ~2=7.59,P<0.05)。结论 ICA及AIS的发生发展与HR-HPV(16/18)感染密切相关,呈现p16、ki67的强阳性高表达。HR-HPV(16/18)感染与p16阳性存在高度一致性。单一HPV18型感染多见于ICA,单一HPV16型感染多见于AIS。宫颈活检或锥切标本为AIS且伴单一HPV18感染时,需要警惕ICA的可能。
Objective To investigate the value of high-risk human papillomavirus (HR-HPV) infection and immunohistochemical p16 and Ki67 in diagnosis of cervical adenocarcinoma and adenocarcinoma in situ (AIS).Methods Eighty-two cases of cervical glandular epithelial lesions diagnosed in Shaoxing Women and Children Health Hospital from January 2016 to December 2017 were selected,including 18 cases of AIS,23 cases of invasive adenocarcinoma (ICA),and 41 cases of benign endocervical glands (BEG).HR-HPV typing and expressions of immunohistochemical p16 and Ki67 were analyzed.Results The positive rate of HR-HPV in ICA and AIS was 85.37%(35/41),of which HPV16/18 type occupied 94.28%(33/35).HR-HPV positive rate in BEG was 36.59%(15/41),including 66.67%(10/15) of HPV16/18 type.The difference was statistically significant (χ 2 value was 20.50 and 6.65,respectively,both P <0.05).In the comparison between ICA and AIS,the detection rate of single HPV16 was 27.27%(3/11) and 72.73%(8/11),which was statistically different from that of single HPV18 [66.67%(10/15),33.33%(5/15)](χ^2=3.94, P <0.05).The diagnostic sensitivity,specificity,positive predictive value and negative predictive value of p16 combined with Ki67 in ICA and AIS were 94.12%,97.37%,96.97% and 94.87%,respectively.Thirty-five cases of HR-HPV positive in ICA and AIS showed p16 positive,and 6 cases of HR-HPV negative in ICA showed p16 negative.Among 35 cases of HR-HPV positive in ICA and AIS,33 cases were HPV16/18 and p16 positive (94.29%),and 2 cases HPV16/18 and p16 positive (13.33%) in 15 cases of HR-HPV positive in BEG.The difference was statistically significant (χ^2=7.59, P <0.05).Conclusion The occurrence and development of ICA and AIS are closely related to HR-HPV (16/18) infection,showing strong positive and high expression of p16 and Ki67.HR-HPV (16/18) infection is highly consistent with p16 positive.The single HPV18 infection is mostly found in ICA,and the single HPV16 infection is mostly found in AIS.When AIS combining single HPV18 infection is diagnosed with cervical biopsy or conization,it is necessary to be aware of the residual lesions as ICA.
作者
戈文舜
包磊
鲁波
任丽芳
李美平
杨惠英
蔡红光
GE Wenshun;BAO Lei;LU Bo;REN Lifang;LI Meiping;YANG Huiying;CAI Hongguang(Department of Pathology,Shaoxing Women and Children Health Hospital,Zhejiang Shaoxing 312000,China)
出处
《中国妇幼健康研究》
2019年第3期311-315,共5页
Chinese Journal of Woman and Child Health Research
基金
浙江省公益性技术研究社会发展资助项目(2016C33223)
关键词
宫颈浸润性腺癌
原位腺癌
高危型人乳头瘤病毒
P16
KI67
invasive cervical adenocarcinoma (ICA)
adenocarcinoma in situ (AIS)
high-risk human papillomavirus (HR-HPV)
p16
ki67
