P16及Ki67在宫颈病变病理诊断中的应用
| 作者: |
1刘镜文,
1和月生,
1胡慧珍,
1刘文科,
1吴彬,
2吴秋良
1 惠州市妇幼保健计划生育服务中心病理科，广东 惠州 516211 2 中山大学肿瘤防治中心病理科，广州 510060 |
| 通讯: |
刘镜文
Email: 6615151@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2018.03.003 |
| 基金: | 广东省惠州市科技局项目(2016Y051)。 |
摘要
目的：评价P16INK4a与Ki67 两个辅助指标对提高基层病理医师在宫颈上皮病变诊断准确性中的作用。方法：选取207个宫颈活检病例行HE染色及P16INK4a，Ki67免疫组织化学染色，分2次邀请5名县市级医院病理医师进行诊断。第一次每位病理医师只阅读常规HE染色切片进行诊断，对比5名病理医师之间诊断的一致性；半年后再次邀请这5名病理医师结合P16INK4a，Ki67免疫组织化学切片进行诊断，对比病理医师之间诊断的一致性，并计算前后2次阅片Kappa值及符合率，最后对比5名病理医师的诊断与参考标准之间的一致性及符合率，分析其统计学意义。结果：单独依靠常规HE切片进行诊断时，病理医师之间的诊断一致性及病理医师与“参考标准”之间的诊断一致性为弱至中度(Kappa值分别为0.344±0.072，0.385±0.053)，符合率较低(55%~70%，60%~65%)。但联合P16INK4a及Ki67结果进行诊断，病理医师之间的诊断一致性及病理医师与“参考标准”之间的诊断的一致性可达到高度或极强(Kappa值分别为0.700±0.051，0.792±0.043)，符合率分别提高到78%~88%与85%~91%，两组指标差异均有统计学意义(P<0.05)。结论：联合应用P16INK4a及Ki67免疫组织化学检测结果，可明显提高临床上宫颈活检病变诊断的准确性。
关键词：
宫颈病变；诊断；准确性；P16；Ki67
Application of P16 and Ki67 in the pathological diagnosis of cervical lesions
CorrespondingAuthor: LIU Jingwen Email: 6615151@qq.com
DOI: 10.3978/j.issn.2095-6959.2018.03.003
Foundation: This work was supported by Huizhou Science and Technology Bureau of Guangdong Province, China (2016Y051).
Abstract
Objective: To evaluate the role of P16INK4a and Ki67 in improving the accuracy of the cervical intraepithelial neoplasia pathology diagnosis. Methods: A total of 207 cases of cervical biopsy were selected by routine HE staining and P16INK4a, Ki67 immunohistochemical staining. We invited five pathologists, first each pathologist reading routine HE staining for diagnosis; after half a year, invited the same five pathologists reading routine HE sections and P16INK4a, Ki67 for diagnosis again, and compared the interobserver agreement, calculated the coincidence rate. Finally, we compared the five pathologists diagnosis with the reference standard and calculated the coincidence rate. Results: The diagnosis relied solely on conventional HE slides, the interobserver agreement was weak to moderate and the coincidence rate was low. The agreement between pathological diagnosis and the reference standard, and coincidence rate were the same (the Kappa values were 0.344±0.072, 0.385±0.053, and the coincidence rate were 55%–70%, 60%–65%, respectively). But combination with P16INK4a and Ki67 for diagnosis, the interobserver agreement reached high or extremely strong level, and the coincidence rate were significantly increased (the Kappa values were 0.700±0.051, 0.792±0.043, and the coincidence rate were 78%–88%, 85%–91% respectively). The difference between the two groups was statistically significant (P<0.05). Conclusion: Combined with P16INK4a and Ki67 immunohistochemical staining, pathologists can significantly improve the accuracy of the diagnosis of cervical biopsy.
Keywords：
cervical intraepithelial neoplasia; diagnosis; accuracy; P16; Ki67