Colposcopically Directed Biopsy, Random Cervical Biopsy, and Endocervical Curettage in the Diagnosis of Cervical Intraepithelial Neoplasia II or Worse

2006 ◽  
Vol 2006 ◽  
pp. 333-335
Author(s):  
M.E. App
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Cervical Biopsy

scholarly journals Variability of Pathologists' Utilization of p16 and Ki-67 Immunostaining in the Diagnosis of Cervical Biopsies in Routine Pathology Practice and Its Impact on the Frequencies of Cervical Intraepithelial Neoplasia Diagnoses and Cytohistologic Correlations

2014 ◽  
Vol 138 (1) ◽  
pp. 76-87 ◽  
Author(s):  
Charanjeet Singh ◽  
J. Carlos Manivel ◽  
Alexander M. Truskinovsky ◽  
Kay Savik ◽  
Samy Amirouche ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Lower Range ◽  
Ki 67 ◽  
Detection Rates ◽  
Cervical Biopsy ◽  
Biopsy Specimens ◽  
Frequency Of Use ◽  
Lower Variability ◽  
The Impact

Context.—The use of p16 in cervical biopsies improves the accuracy of cervical intraepithelial neoplasia (CIN) diagnosis and grading and decreases its interpathologist variability. Objective.—To determine the impact of the frequency of use of p16 immunostains in cervical biopsies on pathologists' diagnoses of CIN grade 1 and grade 2 or above (CIN1 and CIN2+) and on cytohistologic correlations. Design.—We identified all cervical biopsy specimens with cytologic correlations subjected or not to p16 staining from January 1, 2005, to September 30, 2010; calculated each pathologist's percentage of p16 use; and correlated it with their major cytohistologic discrepancy rates, CIN2+ diagnoses, and CIN1/CIN2+ ratios. Results.—During the study period, each of the 23 pathologists interpreted 59 to 1811 (mean, 518) of 11 850 cervical biopsy specimens, used p16 for 0% to 21.31% (mean, 10.14%) of these, had CIN2+ detection rates of 9.5% to 24.1% (mean, 18.9%), and CIN1/CIN2+ ratios of 0.7 to 4.5 (mean, 1.5). Compared to the 12 “low users” of p16, who used p16 fewer times than the institution's mean for p16 use, the 11 “high users” of p16 diagnosed more biopsies (8391 versus 3459), had a lower rate of major cytohistologic discrepancies (12.62% versus 14.92%, P < .001), a higher rate of CIN2+ diagnoses (19.9% versus 16.4%, P < .001), a lower range of CIN2+ rates (15.0%–23.1% versus 9.5%–24.1%), and lower CIN1/CIN2+ ratios (1.2 versus 2.3). Conclusions.—We found a high intrainstitutional variability of p16 use in cervical biopsies, CIN2+ rates, and CIN1/CIN2+ ratios. Use of p16 for greater than 10% of cervical biopsies was associated with improved cytohistologic correlation rates and with lower variability in the frequencies of histologic diagnoses.

scholarly journals Role of p16/INK4a and Ki-67 as specific biomarkers for cervical intraepithelial neoplasia: An institutional study

2017 ◽  
Vol 9 (02) ◽  
pp. 104-110 ◽  
Author(s):  
Ankitha Hebbar ◽  
Venkataramappa Srinivasa Murthy
Keyword(s):  
Diagnostic Accuracy ◽  
Cervical Intraepithelial Neoplasia ◽  
Squamous Metaplasia ◽  
Intraepithelial Neoplasia ◽  
P Value ◽  
Kappa Statistics ◽  
Histopathological Diagnosis ◽  
Ki 67 ◽  
Cervical Biopsy ◽  
P16 Ink4a

Abstract BACKGROUND: P16/INK4a and Ki-67 have emerged as important biomarkers for the detection of high-risk human papilloma virus (HR-HPV) associated dysplastic changes in the cervical biopsy samples. The increasing inter- and intra-observer variability in the diagnosis of dysplastic lesions and immature squamous metaplasia on histopathology has led to the advent of these biomarkers. This study was taken up with an aim to study their role in increasing the diagnostic accuracy in equivocal cases on histopathology. MATERIALS AND METHODS: Fifty cervical biopsy specimens were stained with p16/INK4a and Ki-67 consisting of 10 cases each of cervical intraepithelial neoplasia (CIN I/II/III) along with five cases of squamous metaplasia. Histopathological diagnosis was considered as the gold standard. Statistical analysis was done by kappa statistics, and P value was calculated. RESULTS: The sensitivity and specificity of p16/INK4a and Ki-67 were 76.2%, 87.5%, 90.5%, and 87.5%, respectively. The overall agreement of both the immunostains with histopathological diagnosis was statistically significant (P < 0.05) and the diagnostic accuracy improved when both the stains were used in conjunction. CONCLUSION: Ki-67 and p16/INK4a can be used as complimentary tests in differentiating dysplastic and nondysplastic lesions and help in confirming the histopathological diagnosis. They aid in recognition of dysplasias caused by HR-HPV, which have higher tendency to progress to neoplasia. However, further research is advocated before the widespread use of these markers for screening of dysplasias.

Significance of Persistent Inflammatory Cervical Smears in Sexually Active Women of Reproductive Age Group—A Prospective Study

2010 ◽  
Vol 2 (1) ◽  
pp. 45-48
Author(s):  
Nidhi Gupta
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Histopathological Examination ◽  
Intraepithelial Neoplasia ◽  
Reproductive Age ◽  
Sexually Active ◽  
Women Of Reproductive Age ◽  
Medical College ◽  
Cervical Smears ◽  
Cervical Biopsy ◽  
Inflammatory Changes

ABSTRACT To study the significance of persistent inflammatory cervical Papanicolaou smears, in sexually active women of reproductive age group attending the out patient department of department of obstetrics and gynecology, Sarojini Naidu Medical College and Hospitals, Agra were recruited. Patients with persistent inflammatory cervical smears were subjected to Schiller directed cervical biopsy for histopathological examination. Persistent inflammatory changes were seen in 37.6% cervical smears. Underlying cervical intraepithelial neoplasia (CIN) on histopathologic examination was found in 13.6% persisters. Prevalence of CIN was higher in women over 30 years and significantly so in women with parity higher than 2. It was further observed that severity of underlying CIN lesions increased with increasing duration of marital life. Objective To study the significance of persistent inflammatory cervical smears in sexually active women of reproductive age. Study design A prospective tertiary teaching hospital based study on 3000 sexually active women aged between 18 to 45 years attending the OPD from October 2006 to December 2008. Material and methods Sexually active women aged between 18 to 45 years with inflammatory smears attending the OPD of the department of obstetrics and gynecology, SN Medical College and Hospital were recruited for the study. Repeat cervical smears were taken after 3 months of systemic antimicrobials plus local antiseptics. Patients with persistent inflammatory cervical smears were subjected to Schiller directed cervical biopsy for histopathological examination. Relationship of age, parity, duration of marital life, different contraceptive practices and other high-risk factors were studied vis-ì-vis histopathological findings of cervical intraepithelial neoplasia. Results Persistent inflammatory changes were noted in 37.6% cervical smears. Underlying cervical intraepithelial neoplasia (CIN) on histopathalogic examination was seen in 13.6% persisters. Prevalence of CIN was higher in women over 30 years, and over para 3 uninfluenced by the presence of cervical lesion. Severity of underlying CIN lesions increased with increasing duration of marital life. Conclusion Women with persistent inflammatory cervical smears, especially if she is above 30 years, sexually active for 10 years and is third para, should have further evaluation with cervical biopsy.

The Utility of p16Ink4a in Discriminating Between Cervical Intraepithelial Neoplasia 1 and Nonneoplastic Equivocal Lesions of the Cervix

2008 ◽  
Vol 132 (5) ◽  
pp. 795-799
Author(s):  
Rachel Redman ◽  
Irina Rufforny ◽  
Chen Liu ◽  
Edward J. Wilkinson ◽  
Nicole A. Massoll
Keyword(s):  
Polymerase Chain Reaction ◽  
High Risk ◽  
Cervical Intraepithelial Neoplasia ◽  
Real Time ◽  
Intraepithelial Neoplasia ◽  
Cervical Lesions ◽  
Chain Reaction ◽  
Cervical Biopsy ◽  
Polymerase Chain ◽  
High Risk Hpv

Abstract Context.—The protein p16Ink4a is overexpressed in cervical lesions associated with high-risk human papillomavirus (HPV) subtypes 16 and 18, but not in low-risk HPV subtypes 6 and 11 or non–HPV-associated cervical lesions. Objective.—To determine whether p16Ink4a expression in equivocal cervical lesions helps distinguish atypical non-HPV changes from HPV-related changes. Design.—One hundred ninety-one cervical lesions, including 81 cervical intraepithelial neoplasia 1, 52 squamous metaplasia, 33 cellular features suggestive of HPV-related change, 9 reserve cell hyperplasia, 4 microglandular hyperplasia, and 12 inflammatory cervicitis, were randomly selected from archival cervical biopsy specimens. All 191 samples were studied with p16Ink4a (JC8 monoclonal antibody). Reactivity for p16Ink4a was scored on a 3-tier system as follows: negative, 0% to 5% cells reactive; focal/scattered positive, greater than 5% and less than or equal to 80% cells reactive; diffuse positive, greater than 80% cells reactive. Reactivity was based on normal/reactive cervical specimens where anti-p16 antibody was negative/weakly expressed in non–cervical epithelial cells. Cervical intraepithelial neoplasia 1 lesions not reactive for p16Ink4a were investigated for the presence of high-risk HPV by real-time polymerase chain reaction. Results.—No p16Ink4a reactivity was detected in the cervical lesions associated with atypical non-HPV change. Eleven of the cervical intraepithelial neoplasia 1 lesions showed focal/scattered reactivity expression for p16Ink4a, and 19 of the CIN 1 lesions had diffuse reactivity. Fifty of 51 of the CIN 1 lesions negative for p16Ink4a were real-time polymerase chain reaction negative for the presence of high-risk HPV; 1 was real-time polymerase chain reaction positive for high-risk HPV. Conclusions.—The data support the routine use of p16Ink4a immunohistochemical evaluation of cervical biopsy specimens for better discrimination of non–HPV-associated lesions from HPV-related lesions.

Inflammatory Cytology, Infection and Intraepithelial Neoplasia

1992 ◽  
Vol 3 (2) ◽  
pp. 123-124 ◽  
Author(s):  
A J Robinson ◽  
D E Mercey ◽  
M Preston ◽  
J S Bingham
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Transmitted Disease ◽  
Intraepithelial Neoplasia ◽  
Genital Infection ◽  
Sexually Transmitted ◽  
Cervical Biopsy ◽  
High Incidence ◽  
Prognostic Implications ◽  
Inflammatory Changes

The prognostic implications of minor grades of abnormality on cervical cytology are unclear. Women attending genitourinary medicine clinics who had cytology showing inflammatory changes with or without koilocytosis or borderline dyskaryosis have a high incidence of cervical intraepithelial neoplasia and genital infection. Of 119 patients who had a colposcopically directed cervical biopsy after one smear showing these changes, 46 (38%) had cervical intraepithelial neoplasia. Seventy-eight (57%) of 138 women had genital infection of whom 26 (33%) had a sexually transmitted disease. We recommend vigilant follow-up of borderline cytology including colposcopy if adequate facilities exist.

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