The Value Of P16^INK4a Protein Detection In Cervical Cytology For The Screening Of Cervical Precancerous Lesions And Cervical Cancer

Objective:To explore the value of cervical P16 immuno-stained cytology in the diagnosis of high-grade cervical intraepithelial neoplasia and cervical cancer in cervical cancer screening.Methods:A total of 790 women aged 20-70 who were screened for cervical cancer in the gynecology clinic of The First Affiliated Hospital of Bengbu Medical College from May to August 2020 were selected for high-risk human papillomavirus（HPV）detection,liquid-based thin layer cytological（TCT）detection and P16^INK4acytology detection.Any of whose tests was positive and patients with obvious clinical symptoms and highly suspected cervical lesions were referred to colposcopy and biopsy.To compare the detection effect of HPV,TCT and P16 alone and in combination with pairwise screening in the identification of cervical precancerous lesions and cervical cancer.Results:Among all the screening subjects,the positive rate of P16（14.6%）was similar to that of TCT≥ASCUS（16.3%）,which was lower than that of HR-HPV（25.6%）.A total of 270 cases were positive in any screening,17cases were all negative but had obvious clinical symptoms.A total of 210women were recalled to undergo colposcopy biopsies.Among them,131 cases were diagnosed as chronic inflammation by histopathology,41 cases were LSIL,30 cases were HSIL and 8 cases were cervical cancer.The positive rates of P16 in chronic cervicitis,LSIL,HSIL and cervical cancer were 30.5%,36.5%,83.3%and 100.0%,respectively.The positive rates of P16 increased with the increase of the severity of cervical lesions（χ²=34.57,P<0.01）.The sensitivity of P16 detection of HSIL+was lower than that of HPV detection（86.8%vs 89.5%,P>0.05）,but the specificity was higher（91.9%vs 80.3%,P<0.05）.The sensitivity of P16 plus TCT to detect HSIL+is 92.1%,which was lower than that of HPV plus TCT（94.7%）and P16 plus HPV（97.4%）（P>0.05）.The specificity of P16 plus TCT testing was 85.6%,which was higher than that of HPV plus TCT testing（77.5%）and P16 plus HPV testing（78.8%）（P<0.05）.The area under the curve of HPV,TCT,P16,HPV+TCT,P16+HPV,P16+TCT in the diagnosis of cervical lesions are 0.849,0.822,0.893,0.861,0.881,0.889,respectively.The diagnostic value of each index for cervical lesions is statistically significant（P<0.01）.Conclusion:1.The positive rate of P16 detection has a significant correlation with the progress of cervical lesions.As the degree of cervical lesions increases,the more P16 is expressed in cells,the higher the positive rate.2.Cytology P16 detection has good diagnostic value in cervical cancer screening,which can improve the detection efficiency of HSIL+,reduce the rate of misdiagnosis,and prevent overtreatment.3.Compared with HPV plus TCT testing,P16 plus TCT testing has similar sensitivity and higher specificity for HSIL+screening,and can be used as a new screening method for cervical cancer.