Dual p16 and Ki-67 Expression in Liquid-Based Cervical Cytological Samples Compared to Pap Cytology Findings, Biopsies, and HPV Testing in Cervical Cancer Screening: A Diagnostic Accuracy Study

Acta Cytol. 2018;62(2):104-114. doi: 10.1159/000487504. Epub 2018 Mar 22.

Abstract

Objective: Our objective was to verify the sensitivity and specificity of dual immunocytochemistry staining for p16 and Ki-67 in liquid-based samples (the "dual" assay) for cervical lesion screening, compared to biopsy findings and human papillomavirus (HPV) DNA molecular detection.

Study design: Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for the "dual immunocytochemistry assay" were calculated and compared to histopathological results and to high-risk HPV DNA detection in adult women or teenagers submitted to cervical cancer screening.

Results: A total of 151 women were included. The majority (96.2%) of those with negative dual assay results had lower biopsy grades (p < 0.001). Women with cytology results suggestive of cervical cancer had positive dual immunocytochemistry assay results more frequently (p < 0.001), and these positive results were also significantly associated with biopsy findings (p < 0.001) and with high-risk genotype HPV infection (p = 0.007). Specificity and PPV for the dual assay were 0.972 (0.855-0.999) and 0.800 (0.284-0.995), respectively, and 1.000 (0.590-1.000) and 1.000 (0.631-1.000) for HPV detection.

Conclusions: The dual immunocytochemistry assay had high specificity and PPV. It reveals a persistent HPV infection, avoiding the need for new tissue collections for biopsies or hybrid capture.

Keywords: Cervical intraepithelial neoplasia; Cyclin-dependent kinase inhibitor p16; Cytological techniques; Diagnostic techniques; Genes; Immunocytochemistry; Ki-67 antigen; Papanicolaou test; Uterine cervical dysplasia; Uterine cervical neoplasms.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Area Under Curve
  • Cyclin-Dependent Kinase Inhibitor p16 / analysis*
  • DNA, Viral / genetics*
  • Female
  • Human Papillomavirus DNA Tests*
  • Humans
  • Immunohistochemistry*
  • Ki-67 Antigen / analysis*
  • Liquid Biopsy
  • Middle Aged
  • Papanicolaou Test*
  • Papillomaviridae / genetics*
  • Papillomavirus Infections / pathology
  • Papillomavirus Infections / virology*
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Reproducibility of Results
  • Squamous Intraepithelial Lesions of the Cervix / metabolism*
  • Squamous Intraepithelial Lesions of the Cervix / pathology
  • Squamous Intraepithelial Lesions of the Cervix / virology
  • Uterine Cervical Dysplasia / chemistry*
  • Uterine Cervical Dysplasia / pathology
  • Uterine Cervical Dysplasia / virology
  • Uterine Cervical Neoplasms / chemistry*
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / virology
  • Vaginal Smears
  • Young Adult

Substances

  • CDKN2A protein, human
  • Cyclin-Dependent Kinase Inhibitor p16
  • DNA, Viral
  • Ki-67 Antigen