Precancerous lesions of the cervix. Biomarkers in cytological diagnosis
Despite the success of the German screening program for cervical cancer a new discussion has started with the aim to improve its quality. The main reason for this new discussion has been the finding of many international studies that the quality of screening programs could be improved by introducing human papillomavirus (HPV) testing. It is well known that the sensitivity of the HPV test is much better than that of a single Papanicolaou (PAP) smear. On the other hand, it is generally accepted that the specificity of the established HPV tests is significantly lower than that of cytology, i.e. the HPV test produces more false positive diagnoses. The introduction of new biomarkers could solve this problem and one of these biomarkers is p16(INK4a) which is a surrogate marker for the oncogenic transformation of cervical cells. Using this biomarker it is now possible to identify cases which should be sent for colposcopy and possibly biopsy directly, among those cases which have been classified cytologically as unclear (ASC-US) or mild and moderately dysplastic cervical intraepithelial neoplasia (CIN 1/2). Moreover, it is now feasible to identify the vast majority of underlying high-grade CIN disease in women tested Pap negative/HPV positive, while reducing the number of colposcopies to a level of approximately 25%. In addition, the combination of p16 and L1 probably allows a better estimate of the prognosis of cases with mild or moderate dysplasia.
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