p16 Immunoreactivity Correlates With Morphologic Diagnosis of HPV-associated Anal Intraepithelial Neoplasia: A Study of 1000 Biopsies.
p16 Immunoreactivity Correlates With Morphologic Diagnosis of HPV-associated Anal Intraepithelial Neoplasia: A Study of 1000 Biopsies.
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p16 免疫反应性与 HPV 相关肛门上皮内瘤变的形态学诊断相关：1000 个活检组织的研究。
DOI：
10.1097/pas.0000000000001769
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Gaisa,MichaelM
中科院分区：
文献类型：
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作者：
Liu,Yuxin;McCluggage,WGlenn;Darragh,TeresaM;Farhat,Nada;Blakely,Morgan;Sigel,Keith;Zheng,Wenxin;Westra,WilliamH;Gaisa,MichaelM
p16是人类乳头瘤病毒（HPV）相关的肛门生殖器病变最有用的诊断标志物。在子宫颈，p16免疫反应模式通常与病变严重程度相关。p16在肛门上皮内瘤变（AIN）中的表达研究甚少。这种相关性是否成立还有待确定。我们将p16免疫组织化学（IHC）结果的程度和模式与1000例肛门鳞状和过渡区活检标本的形态学诊断相关联。使用下肛门生殖器鳞状术语标准，p16免疫组化结果分为块染色、部分染色或阴性。在无AIN形态学证据的150份样本中，85%的p16呈阴性，15%的p16呈部分染色。AIN 1 （n= 400）显示不同的结果：28%阴性，35%部分染色，37%块染。AIN 2 （n= 298）中89%为阻滞，9%为部分染色，2%为阴性。AIN 3 （n= 152）显示阻滞（95%）或部分染色（5%）。对于AIN 2/3的检测，p16块染色的灵敏度为91%，特异性为73%，阳性预测值为80%，阴性预测值为91%，约登指数为0.64。块染色和部分染色联合使用可略微提高灵敏度（99%）和阴性预测值（98%），但显著降低特异性（43%）、阳性预测值（59%）和约登指数（0.42，P< 0.001）。与子宫颈一样，p16免疫反应性与AIN的形态学诊断相关。块染色对AIN 2/3具有最佳的诊断价值。注意，因为AIN 1经常出现块状染色；p16的预后价值有待进一步研究。
p16 is the most useful diagnostic marker for human papillomavirus (HPV)-associated anogenital lesions. In the cervix, the pattern of p16 immunoreactivity generally correlates with lesion severity. p16 expression in anal intraepithelial neoplasia (AIN) is far less studied. Whether such correlation holds true has to be determined. We correlated the degree and pattern of p16 immunohistochemistry (IHC) results with morphologic diagnoses of 1000 anal squamous and transitional zone biopsy specimens. Using the Lower Anogenital Squamous Terminology criteria, p16 IHC results were classified as block staining, partial staining, or negative. Among 150 samples without morphologic evidence of AIN, p16 was negative in 85% and partial staining in 15%. AIN 1 (n= 400) revealed diverse results: 28% negative, 35% partial, and 37% block staining. Among AIN 2 (n= 298), 89% were block, 9% partial staining, and 2% negative. AIN 3 (n= 152) revealed block (95%) or partial staining (5%). For the detection of AIN 2/3, p16 block staining yielded 91% sensitivity, 73% specificity, 80% positive predictive value, 91% negative predictive value, and a Youden Index of 0.64. Combining block staining and partial staining slightly increased sensitivity (99%) and negative predictive value (98%), but significantly decreased specificity (43%), positive predictive value (59%) and Youden Index (0.42, P< 0.001). As with the cervix, p16 immunoreactivity correlates with morphologic diagnoses of AIN. Block staining offers the optimal diagnostic value for AIN 2/3. Caution is required since AIN 1 frequently exhibits block staining; the prognostic value of p16 warrants further investigation.