Journal of Cytology
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ORIGINAL ARTICLE
Year : 2021  |  Volume : 38  |  Issue : 4  |  Page : 180-185

P16INK4a/ki67 immunocytochemistry in improving the predictive value for high grade cervical intraepithelial (≥CIN2) neoplasia in pap smear


1 Department of General Pathology Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Gynecological Oncology Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Anne Jennifer Prabhu
Department of General Pathology, Christian Medical College, Vellore - 632004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JOC.JOC_245_20

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Introduction: Cervical cytology has limited sensitivity to detect cervical pre-cancerous lesions. High-risk human papillomavirus (hr-HPV) DNA testing has high sensitivity but its specificity is limited. This study was done to assess the utility of p16INK4a/ki-67 dual stained cytology in improving the predictive value for high-grade cervical (CIN2+) lesions. Aim/Objective: To assess the significance of P16/Ki-67 immunocytochemistry in improving the predictive value for high-grade cervical intraepithelial (≥CIN 2+) lesions on Pap smear. Material and Methods: This was a prospective diagnostic study that included 93 patients with ASC-US/LSIL/ASC-H and HSIL on thin prep cervical smears and who also underwent hr-HPV DNA test and colposcopy-guided biopsy. Biopsy was the gold standard against which the performance of P16INK4a/Ki-67 and hr-HPV results were compared. Results: In women of all ages, sensitivity of (96.8%) hr-HPV test and p16/Ki-67 dual immunocytochemistry (≥1 positive cell) were similar and negative predictive value (NPV) was (97.1% vs. 97.9%) but the latter test showed better specificity (69.4% vs. 53.2%) and positive predictive value (PPV, 61.2% vs. 50.8%) for ≥CIN 2 lesions. A higher cut off of at least 10 positive cells gives a higher specificity and PPV, with slightly decreased sensitivity and NPV. Conclusion: Because high-risk HPV test has a high sensitivity and NPV, whereas P16/Ki-67 dual immunocytochemistry (≥10 positive cells) has a high specificity and PPV, the latter can be recommended as an ancillary test in hr-HPV-positive women to reduce the number of women going for colposcopy and biopsies.


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