[Immunocytochemistry of p16(INK4a) and Ki-67 as adjunctive method for routine gynecological cytology of mild and moderate dysplasia.]

Gemeinschaftspraxis für Pathologie, Amtsstr. 5 a, 14469, Potsdam, Deutschland, .
Der Pathologe (Impact Factor: 0.39). 07/2012;
Source: PubMed


Especially the cytological diagnoses of mild and moderate dysplasia are often followed by unnecessary stigmatization of patients and uncertainty in further clinical follow-up and therapy. Data from 222 patients including additional investigations by high-risk human papillomavirus (HPV) testing and combined immunocytochemistry for p16(INK4a) and Ki-67 were documented, including cytological and histological follow-up. Overall for cytology, high risk HPV testing and dual staining the following characteristics concerning the presence of cervical intraepithelial neoplasia (CIN) 2+ were calculated (in %): sensitivity 100, 95.8 and 92.4, specificity -, 23.3 and 72.8, positive predictive value 53.6, 59.1 and 79.7, negative predictive value -, 82.8 and 89.3, respectively.There was a statistically significant advantage for higher specificity and positive predictive value for dual staining, especially for cytological diagnosis of low grade dysplasia. An objective individual risk stratification of patients with cytology of mild or moderate dysplasia is not available but the uncertainty in the management of these patients will be clearly reduced.

1 Follower
10 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: After nearly ten years' experience now in the use of Papanicolaou IIID as an expression of a cytologically recognizable mild or moderate dysplasia this study intends to analyse the diagnostic precision and practicability of Papanicolaou IIID by means of IIID-cases registered during the years 1971-1973. Of 1343 patients with a mild or moderate dysplasia 1099 cases were definitively verified in their further development (244 cases were lost). 63.5% showed a regression, i.e. from 4 months to 2 years after cytological diagnosis IIID they had either at least two negative cytological results or an unsuspicious histological statement. In 11.3% only one negative cytological statement was registered; 14% of all IIID-cases could be confirmed by following histological examination. Only 11.2% showed a progression to severe dysplasia or carcinoma in situ or to micro-carcinoma (3 cases) and invasive carcinoma (3 cases); in these latter cases our advice to control the smear in intervals of 3 months was not observed. The high spontaneous remission rate of Papanicolaou IIID does not seem to justify a histological verification of this dysplasia grade, the less so since it could be proved that 84% of the reversible IIID-diagnoses were cytologically definitely negative within 8 months. The histologically verified IIID-cases showed a congruence between cytological and histological statements clearly depending on the technique of taking tissue and on the interval between the cytological and histological diagnosis. As to the dianostic precision against advanced precancerous lesions it could be proved - with an error quota of 2.3% - that group IIID rarely included a cytological undervaluation. Progressive developments could be registered early enough by punctual cytological control. Altogether the presented statistical data underlines the high diagnostic rank of group IIID in contrast to cytological diagnosis of group III and to those cellular changes which have on principle to be verified histologically.
    Geburtshilfe und Frauenheilkunde 10/1978; 38(9):726-34. · 0.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The cytological differential diagnosis "dysplasia" was made in 176 cases between January 1968 and June 1975. An immediate microscopic diagnosis was possible in 18 cases (10.22%). 14 cases eluded further follow-up. In 144 cases, long term observation was carried out. In some cases up to 6 years. Cytological regression to a permanently negative smear occurred in 57 patients (39.58%). A microscopic confirmation of the diagnosis was not obtained in these patients. In cytologically persistent cases microscopic confirmation was obtained after varying times of observation. The cytological differential diagnosis was correct in comparison to the histologic findings in 82.6% of the cases. 62 cases of the total (43.05%) showed cytological persistence of the suspicious smear. A cytological progression became apparent in 25 cases (17.36%) and was always subjected to microscopic confirmation by cone biopsy or primary hysterectomy. In 71 cases with microscopic confirmation persistent dysplasia was found in 64.78% of the cases and a progression occurred in 30.98% of the cases. 21.12% showed carcinoma in situ, 7.04% (5) cases showed a microinvasive carcinoma and 2 cases (2.82%) showed an invasive carcinoma. Cervical dysplasias are apparently capable of regression in a large number of cases. However about 10% of the cases will show progression to a micro-invasive or invasive carcinoma after varying lengths of time. In order to avoid unnecessary operations and to improve our knowledge on the biology of dysplasias, observation with cytological diagnosis dysplasia (Papanicolaou 3D) is justified.
    Geburtshilfe und Frauenheilkunde 07/1977; 37(6):521-6. · 0.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Five hundred and fifty-five women with cervical cytologically diagnosed mild cervical dysplasia were followed by cytology without major treatment. Biopsies were performed in 14% resulting in no significant influence on the outcome of the studied material. Regression to normal occurred in 62% (follow-up 39 months), progression to severe dysplasia/carcinoma in situ/invasive carcinoma in 16% (invasive carcinoma: two patients), and persistence of dysplasia in 22%. Life table analysis calculated the risk of progression of mild dysplasia to be 250 to 800/100,000 women/year. A comparison with the incidence of carcinoma in situ, four of 100,000 women/year, illustrates the yearly risk for a woman with mild dysplasia as 560 times greater than for a woman without cervical dysplasia to develop severe dysplasia/carcinoma in situ/invasive carcinoma.
    Obstetrics and Gynecology 06/1986; 67(5):665-9. DOI:10.1016/0020-7292(87)90258-X · 5.18 Impact Factor
Show more