P16/KI67 PROGNOSTIC FACTORS IN DETECTION OF CERVICAL CANCER IN WOMEN WITH HIGH RISK HPV

Abstract

Purpose: To study the diagnostic value of liquid cytology and immunocytochemistry in predicting the development of severe forms of intraepithelial neoplasia in women, based on complex cytological parameters and the content of p16ink4a and p53 as a marker of malignancy. Materials and methods:. The clinical material is based on a retro- and prospective study in 201 patients with cervical cancer treated at the RSSPTSOR from 2018 to March 2021 inclusive. The patients were divided into 3 groups: the first - the control group consisted of 101 (36.78±5.17%) patients with cervical cancer who underwent traditional cytological diagnostics, the second group included 65 (63.22±5.17%) patients with the same diagnosis, which was carried out liquid cytology, and the third group of 45 patients underwent cytochemical analyzes. To clarify the accuracy, specificity and sensitivity of the diagnostic study, we compared it with the histological conclusion. Results: An abnormal histological finding was observed in 83.88% of all these women. 50.33% had LSIL, 31.91% HSIL, and 1.64% SCC. Regarding the initial cytological diagnosis of women who underwent biopsy, we found that 78.62% had an initial cytological result of ASCUS and/or LSIL. Of these, only 25.10% had CIN2+ in biopsy specimens. 16.45% had an initial cytological result of HSIL and/or SCC. Of these, 82% had CIN2+ on biopsy. Summarizing the results of LC with histology, 44.8% of women with a positive result for p16/ki67 ICC had CIN2+. 2.9% of women who tested negative for p16/ki67 ICC had CIN2+ (both with HSIL; no SCC). Initial cytology results for these women were ASCUS and LSIL, respectively. CONCLUSIONS: The specificity and positive predictive value of p16/ki67 ICC for the detection of CIN2+ was higher than that of conventional cytology, with a statistically significant difference, which indicates that p16/ki67 ICC is useful as an adjunct to cytology. Its implementation could lead to a reduction of almost 50% (48.1%) in unnecessary referrals for colposcopy and biopsy. The higher specificity and positive predictive value of p16/ki67 ICC compared to cytology is observed in all age groups. The highest sensitivity and p16/ki67 CIC NPV values ​​for predicting CIN2+ were observed in subgroups of younger women (adjusting for any cut-off point up to <35 or over 35 years).