Triage of women with ASCUS and LSIL cytology

BACKGROUND. The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological abnormalities (atypical squamous cells of undetermined significance [ASCUS] and/or low‐grade squamous intraepithelial lesions [LSIL] group) is a major...

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Bibliographic Details
Published inCancer Vol. 111; no. 1; pp. 58 - 66
Main Authors Wentzensen, Nicolas, Bergeron, Christine, Cas, Frederic, Vinokurova, Svetlana, von Knebel Doeberitz, Magnus
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc., A Wiley Company 25.02.2007
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Summary:BACKGROUND. The identification of a small percentage of high‐grade cervical intraepithelial neoplasias (HGCIN) among patients with minor cytological abnormalities (atypical squamous cells of undetermined significance [ASCUS] and/or low‐grade squamous intraepithelial lesions [LSIL] group) is a major problem in cytology‐based cervical cancer screening. The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with HGCIN among those with an ASCUS or LSIL result in Papanicolaou cytology. METHODS. Consecutive liquid‐based cytology specimens of 137 ASCUS and 88 LSIL results were selected from gynecologists who adopted a triage regimen with biopsy under colposcopy 2 months later, independent of the p16INK4a result. p16INK4a stained slides were prepared and independently read by 2 observers, who used a recently described score to categorize p16INK4a stained squamous cells. The endpoint of the study was detection of a biopsy‐confirmed HGCIN. RESULTS. The overall sensitivity and specificity of p16INK4a positive cells with a nuclear score >2 for diagnosis of HGCIN in ASCUS and LSIL cases combined was 96% and 83%, respectively. The sensitivity and specificity in the ASCUS group was 95% and 84%, and 100% and 81% in the LSIL group, respectively. Two observers had a high concordance in assessing p16INK4a stained cells (κ value of 0.841). CONCLUSIONS. These data suggested that the use of p16INK4a as a biomarker combined with nuclear scoring of p16INK4a positive cells in cervical cytology to triage ASCUS and/or LSIL cases allows identification of HGCIN with good sensitivity and specificity. Cancer (Cancer Cytopathol) 2007. © 2006 American Cancer Society. The authors investigated the efficacy of p16INK4a as a biomarker to identify samples of patients with high‐grade cervical intraepithelial neoplasia among those with atypical squamous cells of undetermined significance or low‐grade squamous intraepithelial lesion result in Papanicolaou cytology.
Bibliography:The excellent technical assistance of Denise Eschenbach and Nina Hensch is gratefully acknowledged.
Magnus von Knebel Doeberitz is a shareholder, advisor to, and member of the board of MTM Laboratoies AG, a company that develops and markets products related to the scientific content of this article.
Fax:(011) 49‐6221‐565981
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.22420