Which test is a better strategy to determine the outcome of atypical glandular cell-categorized Pap smears? Immunocytochemical p16INK4A expression or human papillomavirus test--a retrospective cohort study

• Published in: Gynecologic oncology Vol. 99; no. 3; pp. 578 - 584
• Main Authors: Chen, Su-Feng, Yang, Shih-Fang, Chu, Tang-Yuan, Lai, Hung-Cheng, Lin, Ya-Wen, Bai, Chien-Yu, Nieh, Shin
• Format: Journal Article
• Language: English
• Published: United States 01.12.2005
• Subjects: Cervical Intraepithelial Neoplasia - metabolism; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - virology; Cohort Studies; Cyclin-Dependent Kinase Inhibitor p16 - biosynthesis; Female; Humans; Immunohistochemistry; Papanicolaou Test; Papillomaviridae - growth & development; Papillomaviridae - isolation & purification; Papillomavirus Infections - complications; Papillomavirus Infections - metabolism; Papillomavirus Infections - pathology; Papillomavirus Infections - virology; Retrospective Studies; Uterine Cervical Dysplasia - metabolism; Uterine Cervical Dysplasia - pathology; Uterine Cervical Dysplasia - virology; Uterine Cervical Neoplasms - metabolism; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - virology; Vaginal Smears; Viral Load
• ISSN: 0090-8258

This study was to correlate high-risk human papillomavirus (HR-HPV) viral load to p16(INK4A) (p16) expression in atypical glandular cell (AGC)-categorized Pap smears with follow-up biopsies for elucidating their relationships. We enrolled 36 AGC-categorized Pap smears with subsequent follow-up biopsies. HR-HPV viral load was determined by Hybrid Capture II assay in each AGC-diagnosed Pap smear. Both smears and biopsies were immunostained with a primary anti-p16 antibody, clone E6H4. Correlations between HR-HPV viral load in each AGC-diagnosed Pap smear and p16 expression of smears with follow-up biopsies were performed. Comparative analysis of two tests disclosed both consistencies and discrepancies. There were significant differences (P=0.02) between negative or weak p16 expression of Pap smears with the presence of reactive lesion or LSILs/CIN1s in follow-up biopsies and negative HR-HPV viral load. However, no significant difference (P=0.317) was found between p16 expression of Pap smears with the presence of HSIL/CIN2, 3 and AIS or adenocarcinoma in follow-up biopsies and high HR-HPV viral load. In addition, there were significant differences (P=0.012) in specificity, but no significant differences were found in sensitivity (P=0.604), positive and negative predictive value (P=0.066 and 0.264) between p16 immunoexpression and HR-HPV viral load. Pathogenic activity of HR-HPV was indicated by p16 expression on smears and tissue sections, which appears to be a better strategy than HR-HPV viral load test for the detection of clinically insignificant lesions from AGC-categorized Pap smears.