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目的探讨液基细胞学检测(LCT)剩余细胞学标本中p16INK4a、Ki-67的免疫细胞化学染色筛查宫颈鳞状细胞癌和宫颈癌前病变的价值。方法采用免疫细胞化学和免疫组化法对194例细胞学标本和91例组织活检标本进行p16INK4a、Ki-67检测。结果p16INK4a、Ki-67表达阳性率随着宫颈病变程度的加重而升高,与病变级别呈正相关。Ki-67的标记指数(LI)在HSIL组最高,与其他各组间均数的差异显著(P<0.05)。LSIL及其以上病变细胞学p16INK4a和Ki-67与组织学诊断符合率分别为87.3%和80.95%。宫颈脱落细胞学Ki-67、p16INK4a的免疫细胞化学染色检出高级别病变及鳞癌病变的敏感度、特异度分别为83.6%、86.7%和87.1%、100%。结论利用LCT液基细胞学涂片中p16INK4a、Ki-67的免疫细胞化学染色作为辅助诊断指标应用于宫颈癌高危人群筛查,具有重要意义。
Objective To investigate the value of p16INK4a and Ki-67 immunocytochemical staining in remaining cytology specimens of liquid-based cytology (LCT) in the screening of cervical squamous cell carcinoma and precancerous lesions. Methods Immunocytochemistry and immunohistochemistry were used to detect p16INK4a and Ki-67 in 194 cases of cytology and 91 cases of biopsy specimens. Results The positive rates of p16INK4a and Ki-67 increased with the severity of cervical lesions, and positively correlated with the grade of lesions. The labeling index (LI) of Ki-67 was the highest in HSIL group, with significant difference (P <0.05) compared with other groups. The coincidence rates of histological diagnosis and p16INK4a and Ki-67 in LSIL and above lesions were 87.3% and 80.95% respectively. The sensitivity and specificity of immunocytochemical staining of cervical exfoliative cytology Ki-67 and p16INK4a in high grade and squamous cell carcinoma were 83.6%, 86.7% and 87.1%, 100% respectively. Conclusion The immunocytochemical staining of p16INK4a and Ki-67 in LCT liquid-based cytology smears is an auxiliary diagnostic indicator for the screening of high-risk cervical cancer patients and is of great significance.