摘要目的 探讨p16/Ki-67双染检测在宫颈细胞学意义不明的不典型鳞状细胞(ASC-US)分流中的意义.方法 收集2015年3月至2016年1月液基薄层细胞学检查(TCT)诊断为ASC-US的患者样本,TCT检查后6周内进行了阴道镜检查及活检的患者共171例,对其细胞学剩余标本进行p16/Ki-67双染检测,其中90例ASC-US患者同时进行了高危型HPV检测.结果 171例标本中p16/Ki-67双染检测的阳性率为43.9%(75/171),发现宫颈上皮内瘤样病变2级及以上(简称CIN2+,包括CIN2、CIN3和宫颈癌)的灵敏度、特异度、阳性预测值、阴性预测值分别为77.6%(52/67)、77.9%(81/104)、69.3%(52/75)和84.4%(81/96);而高危型HPV检测发现CIN2+的灵敏度、特异度、阳性预测值、阴性预测值分别为100.0%(34/34)、10.7%(6/56)、40.5%(34/84)和6/6.p16/Ki-67双染检测的灵敏度低于高危型HPV检测,但特异度明显更高.结论 p16/Ki-67双染检测能够保持较高的灵敏度,并有更高的特异度,是分流ASC-US的良好方法.

abstractsObjective To investigate the clinical value of p16/Ki-67 immunocytochemistry in patients with atypical squamous cells of undetermined significance(ASC-US).Methods One hundred and seventy-one cases of thin-prep cytology test (TCT) diagnosed as ASC-US underwent p16/Ki-67 immunocytochemistry.All patients had colposcopy and biopsy from March 2015 to January 2016.Ninety of the 171 cases underwent high-risk HPV test at the same time.Results p16/Ki-67 immunocytochemistry was positive in 43.9% (75/171) of the 171 cytology samples;the sensitivity and specificity of p16/Ki-67 immunocytochemistry were 77.6%(52/67) and 77.9%(81/104) in detecting CIN2+, and the positive and negative predictive value were 69.3%(52/75) and 84.4%(81/96),respectively.The sensitivity and specificity in diagnosing CIN2+ were 100.0%(34/34) and 10.7%(6/56) for HPV test, and the positive and negative predictive value were 40.5%(34/84) and 6/6.p16/Ki-67 immunocytochemistry showed lower sensitivity but obviously higher specificity than high-risk HPV detection.Conclusion p16/Ki-67 immunocytochemistry is a good triage test for identifying CIN2+ in ASC-US specimens.