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Review
. 2020 Apr-Jun;37(2):82-86.
doi: 10.4103/JOC.JOC_89_18. Epub 2020 Apr 14.

To Evaluate the Role of p16Ink4a Immunocytochemistry for Detection of CIN2+ in Women Detected Screen Positive by Visual Inspection Using Acetic Acid

Lalita Verma  1 , Saritha Shamsunder  1 , Sunita Malik  1 , Rashmi Arora  2
Affiliations
Review

To Evaluate the Role of p16Ink4a Immunocytochemistry for Detection of CIN2+ in Women Detected Screen Positive by Visual Inspection Using Acetic Acid

Lalita Verma et al. J Cytol. 2020 Apr-Jun.

Abstract

Objective: To evaluate the role of p16Ink4a immunostaining for the detection of cervical intraepithelial neoplasia (CIN2+) in women who had a positive screening test using visual inspection with acetic acid (VIA).

Methods: Opportunistic screening of women (30-50 years) coming to the gynecology clinic by VIA was performed; the screen-positive women were included in the study which had the institutional review board (IRB) approval. A cytology slide for p16Ink4a immunostaining, colposcopy, and biopsy was then performed sequentially. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of p16Ink4a immunocytochemistry were evaluated with histopathology as the gold standard.

Results: p16Ink4a positivity showed a linear correlation with the increasing grade of CIN. p16Ink4a positivity was seen in 6% of CIN 1, 80% of CIN 2, 100% of CIN 3, and squamous cell carcinoma. The sensitivity and specificity of p16Ink4a immunocytochemistry for detecting CIN 2 or more was 87.5% (95%CI 61.65-98.45) and 97.06% (95%CI 84.67-99.93). Colposcopy had an equal sensitivity of 87.5% (95% CI 61.65-98.45) and specificity of 50% (95% CI 32.43-67.57), respectively.

Conclusion: With high sensitivity and specificity, p16Ink4a immunocytochemistry could be a viable option for triaging VIA-positive women.

Keywords: Cervical intraepithelial neoplasia; Human papillomavirus; P16Ink4a immunocytochemistry; colposcopy; visual inspection with acetic acid.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a) Cytology smear showing Intermediate squamous cells with nuclear and cytoplasmic positivity for p16 corresponded to CIN 2 on histopathology. Immunocytochemistry ×400, (b) Cytology smear showing small parabasal cells with nuclear and cytoplasmic positivity for p16 expression corresponded to CIN 3 on histopathology. Immunocytochemistry ×400, (c) Cytology smear showing malignant squamous cells showing nuclear and cytoplasmic positivity for p16 corresponded to squamous cell carcinoma on histopathology. Immunocytochemistry ×100
Figure 2
Figure 2
(a) Cervical intraepithelial neoplasia 2 (CIN 2) on histopathology. H and E, ×400, (b) Cervical intraepithelial neoplasia 3 (CIN 3) on histopathology. H and E, ×200, (c) Keratinizing squamous cell carcinoma on histopathology. H and E, ×200
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