ASSOCIATION OF HUMAN PAPILLOMA VIRUS INFECTION IN UTERINE CERVICAL NEOPLASIA- A CROSS SECTIONAL STUDY
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 26
Abstract
BACKGROUND Cervical cancer is the second most frequent cancer in women in the world. The association of Human Papilloma Virus (HPV) infection with cervical carcinogenesis is well documented and nearly all cervical cancers are caused by persistent infection with some high-risk HPV types. In developed countries, there has been a major decline in cervical-cancer mortality after the introduction of large-scale cytological testing but in developing countries, due to lack of effective screening programmes for cervical cancer no clinically significant reduction in the incidence of cervical cancer has occurred during the past three decades. Pap smear is a routine screening test, but the overall sensitivity in detection of HSIL - precancerous lesion is only 70 to 80% and histopathological diagnosis of cervical biopsy is prone to poor inter observer reproducibility. Immunohistochemical staining for biomarkers like p16INK4a a sensitive marker for Human Papilloma Virus, may provide objective standards to reduce diagnostic variability of cervical biopsy evaluations. Objectives of the study were to study the proportion of HPV infection in uterine cervical neoplasia using immunohistochemistry for the marker p16INK4a in cervical biopsy specimens and to assess the proportion of P16 expression in varying grades of cervical neoplasia included in the study. MATERIALS AND METHODS The study was conducted in the department of pathology, Govt. Medical College, Kottayam for a duration of one year. Study sample included 50 cases of uterine cervical biopsy specimens, histopathologically diagnosed as cervical epithelial neoplasia, received in the Department of Immunohistochemistry for the marker p16INK4a. Immunohistochemistry for the marker p16INK4a was done as per Standard Operating Procedures in all 50 cases and the expression of this protein which is a sensitive marker for Human Papilloma Virus, was studied. 50 cases in which the p16 expression was studied were categorized into p16 positive and negative cases and their histomorphological parameters were compared. The factors studied were age, histological type, differentiation status of tumour, P16 expression and its immunohistochemical score. Statistical analysis is done using SPSS version 17. RESULTS Summarizing the study results, 87% of Squamous Cell Carcinoma studied came under >50 years group. Whereas ˂50 years group included 70% of LSIL and 83.3% of Squamous metaplasia. Well differentiated SCC, moderately differentiated SCC and poorly differentiated SCC were 40%, 57% & 3% respectively. Out of the 50 cases in which p16 IHC study was done, 70% were positive and 30% were negative, from which the prevalence of HPV in our study population is inferred as 70%. In our study 90% cases of SCC and 50% of LSIL were p16 positive. Single case studied each of HSIL, Basaloid SCC and Adenocarcinoma cervix showed positivity for p16. Squamous metaplasia which is the benign epithelial lesion studied showed 100% p16 negativity. 50% of LSIL and the single adenosquamous carcinoma studied were p16 negative. All these results are comparable with other studies. In present study, 3/27 cases of SCC were negative for p16 which is also comparable with other Indian studies. Increasing P16 score was noticed as moving from benign to malignant through premalignant neoplasms. In present study, P16 expression among various degree of differentiation in Squamous Cell Carcinoma did not show statistically significant association, but indicated a trend of increased frequency of positive p16 expression as moving from well differentiated to moderate/poorly differentiated SCC, which is statistically significant. CONCLUSION Present study confirms the association of Human Papilloma Virus (HPV) infection and cervical malignant and premalignant neoplasia which is well recognized worldwide. It also recognizes P16INK4a as a sensitive marker for the presence of HPV and its expression was observed in squamous cell carcinoma, HSIL, LSIL and adenocarcinoma cervix. In this study, increased p16 expression (P16 IHC score) was observed in cervical epithelial neoplasia with increasing severity of lesion. Also, no positive staining of p16 was observed in metaplastic cervical epithelium and so may be helpful in distinguishing from squamous intra epithelial lesions. To conclude, combined use of H&E and P16 immunohistochemistry significantly improves the accuracy of interpreting and grading cervical lesion biopsies and may be incorporated into routine diagnostic/screening algorithm for cervical carcinoma.
Authors and Affiliations
Vadakkoot Padmanabhan Indu, Usha Poothiode, Lailaraji Navamoni, Pulickal Hariharan Prasad
Keywords
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- EP ID EP567145
- DOI 10.18410/jebmh/2018/410
- Views 52
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