Immunohistochemical Expression of the Tumor Suppressor Protein p16^INK4a in Cervical Adenocarcinoma

Abstract

Objective To evaluate the diagnostic utility of the p16^ink4a protein expression as a marker for adenocarcinoma of the cervix.

Methods In a cross-sectional study, p16^ink4a expression was evaluated in 30 cervical biopsies from patients diagnosed with invasive adenocarcinoma from 2 reference clinics in Brazil, and compared with 18 biopsies of endocervical polyps (control cases). The performance of the tests for p16^ink4a was evaluated using a conventional contingency table, and the Kappa (κ) index was used to evaluate the agreement of the marker with the tissue diagnosis.

Results In total, 66% of the invasive adenocarcinoma cases were positive for p16^ink4a. All of the adenomatous polyps cases used as negative controls were shown to be negative for p16^ink4a. The marker showed a high sensitivity and a high negative predictive value. The Kappa index was good for p16^ink4a (κ = 0.6).

Conclusion Considering the strong association between the p16^ink4a marker and the cervical adenocarcinoma, its use represents an important tool for reducing incorrect diagnoses of adenocarcinoma and thereby avoiding overtreatment.

Resumo

Objetivo Avaliar a utilidade diagnóstica da expressão da proteína p16^ink4a como marcador de adenocarcinoma do colo.

Métodos Em estudo transversal, a expressão de p16^ink4a foi avaliada em 30 biópsias cervicais de pacientes diagnosticadas com adenocarcinoma invasivo de colo uterino provenientes de dois serviços de referência no Brasil, comparando com achados em 18 biópsias de pólipos endocervicais (grupo de controle). Para avaliar a performance do teste, foi utilizada tabela de contingência convencional, e para avaliar a concordância com o diagnóstico, foi aplicado o índice de Kappa (κ).

Resultados No total, 66% dos casos de adenocarcinoma invasivo foram positivos para p16^ink4a. Todos os pólipos adenomatosos foram negativos para p16^ink4a. O marcador mostrou uma alta sensibilidade e alto valor preditivo negativo. O índice de Kappa foi bom para p16^ink4a (κ = 0.6).

Conclusion Considerando a forte associação entre o marcador p16^ink4a e o adenocarcinoma cervical, seu uso representa uma ferramenta importante para reduzir o risco de diagnóstico incorreto de adenocarcinoma e, por conseguinte, evitar o excesso de tratamentos.

Keywords

p16^INK4a - adenocarcinoma - cervix - immunohistochemistry

Palavras-chave

p16^INK4a - adenocarcinoma - colo uterino - imunoistoquímica

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