Investigating Diagnostic Problems of CIN1 and CIN2 Associated With High-risk HPV by Combining the Novel Molecular Biomarker PanHPVE4 With P16INK4a.
新型分子生物学标记PanHPVE4联合P16INK4a对伴高危型HPV感染CIN1和CIN2的诊断性问题研究
van Baars R,Griffin H,Wu Z,Soneji YJ,van de Sandt MM,Arora R,van der Marel J,Ter Harmsel B,Jach R,Okon K,Huras H,Jenkins D,Quint WG,Doorbar J
Abstract
Grading cervical intraepithelial neoplasia (CIN) determines clinical management of women after abnormal cytology with potential for overdiagnosis and overtreatment. We studied a novel biomarker of human papillomavirus (HPV) life-cycle completion (panHPVE4), in combination with the minichromosome maintenance (MCM) protein cell-cycle marker and the p16 transformation marker, to improve CIN diagnosis and categorization. Scoring these biomarkers alongside CIN grading by 3 pathologists was performed on 114 cervical specimens with high-risk (HR) HPV. Interobserver agreement for histopathology was moderate (κ=0.43 for CIN1/negative, 0.54 for CIN2/≤CIN1, and 0.36 for CIN3). Agreement was good or excellent for biomarker scoring (E4: κ=0.896; 95% confidence interval [CI]: 0.763-0.969; p16: κ=0.798; 95% CI: 0.712-0.884; MCM: κ=0.894; 95% CI: NC (this quantity cannot be calculated). Biomarker expression was studied by immunofluorescence and immunohistochemistry and was correlated with 104 final CIN diagnoses after histologic review. All 25 histologically negative specimens were p16 and panHPVE4 negative, although 9 were MCM-positive. There were variable extents of p16 positivity in 11/11 CIN1 and extensive panHPVE4 staining in 9/11. Ten CIN2 lesions expressed panHPVE4 and p16, and 13 CIN2 expressed only p16. CIN3 showed extensive p16 positivity with no/minimal panHPVE4 staining. PanHPVE4, unlike MCM, distinguished CIN1 from negative. PanHPVE4 with p16 separated CIN2/3 showing only expression of p16, indicating transforming HR-HPV E7 expression, from CIN1/2 showing completion of HR-HPV life cycle by E4 expression and variable p16 expression. PanHPVE4 and p16 staining are complementary markers that could provide simple, reliable support for diagnosing CIN. Their value in distinguishing CIN1/2 that supports HR-HPV life-cycle completion (and which might ultimately regress) from purely transforming CIN2/3 needing treatment warrants further research.
摘要
发现女性宫颈细胞学存在异常之后,对宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的分级决定着其临床处理,这其中难免会存在潜在的过度诊断和过度治疗。我们研究了人乳头瘤病毒(human papillomavirus,HPV)全周期过程中的新型生物学标记panHPVE4、联合细胞周期中微染色体修复(minichromosome maintenance,MCM)蛋白以及转录标记p16来改善CIN的诊断和分类。3位病理学家对114例伴高危型(high-risk,HR)HPV感染宫颈样本进行CIN分级并进行标记物的评分。组织病理学内部判读的一致性中等(CIN1/无CIN病变的 κ值为0.43,CIN2/≤CIN1的κ值为0.54,CIN3的κ值为0.36)。生物学标记评分的一致性很好或极好(E4:κ=0.896,95% 可信区间[CI]为0.763-0.969; p16: κ=0.798,95% CI为0.712-0.884;MCM: κ=0.894,95% CI无法计算])。通过免疫荧光和免疫组化方法研究生物学标记的表达,并且与组织学复审后最终诊断为CIN的104例病例进行相关性研究。所有25例无CIN病变组织学样本中,p16和panHPVE4均呈阴性,其中9例MCM呈阳性。11例CIN1样本中,p16呈不同程度阳性(11/11),其中9例panHPVE4呈弥漫阳性(9/11)。10例CIN2表达panHPVE4和p16,13例CIN2仅表达p16。CIN3显示p16弥漫表达,不伴/伴极少量panHPVE4表达。与MCM不同,panHPVE4能够鉴别CIN1和无CIN病变组织学样本。panHPVE4和p16能够将CIN2/3与CIN1/2区分开来,其中CIN2/3为仅见p16表达(提示向HR-HPV E7表达的转化),而CIN1/2为E4表达,表明HR-HPV是全周期;p16的表达程度不等。PanHPVE4和p16染色是两种互补性标记,对于CIN的诊断能够提供简单、可靠的帮助。它们在鉴别HR-HPV完成全部生命周期的CIN1/2和需要治疗、单纯转化为CIN2/3方面的价值值得更进一步研究。
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