oa Southern African Journal of Epidemiology and Infection - The use of p16ink4a in further defining atypical squamous cells cannot exclude a high grade lesion on cervical cytology (ASC-H) : results of a pilot study
According to the Bethesda System, the most widely used terminology system for reporting cervical cytology, the category ASC-H, is defined as cells suggestive of a high grade squamous intraepithelial lesion (HSIL) but are qualitatively or quantitatively insufficient for definitive interpretation. It is estimated that 20-50% of women with an ASC-H diagnosis are on colposcopy found to have HSIL. The management of ASC-H is the same as for HSIL viz referral for colposcopy and directed biopsy. An over-expression of p16ink4A, a cyclin dependent kinase inhibitor in human papillomavirus-induced cancers and precancerous lesions of the uterine cervix, has recently been described. The objective of this pilot study was to assess the utility of p16ink4a in determining management of women with an ASC-H diagnosis on cervical cytology to improve selection of patients requiring referral for colposcopy and biopsy. Twenty-five smears called ASC-H on cytology and 10 negative cervical smears were subjected to p16ink4A staining using the Cintec p16ink4A cytology kit (Dako, Glostrup, Denmark, based on technology licensed from MTM Laboratories AG, Germany). Positive p16ink4A staining was observed in all 21 smears called ASC-H on cytology that had histological evidence of HSIL and in two smears called ASC-H on cytology that showed a low grade squamous intraepithelial lesion on histology. Negative p16ink4A staining was observed in all 10 cervical smears reported as negative and in two smears called ASC-H on cytology, which proved negative on biopsy. P16ink4A appears to offer a more independent parameter to further define the category of ASC-H and help to select those women who require additional management. Larger studies in this regard are warranted.
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