A LASTing impression

Incorporating p16 immunohistochemistry into routine diagnosis of cervical neoplasia

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

The discovery that persistent cervical infections by approximately 15 cancer-associated or high-risk human papillomavirus (HPV) genotypes cause virtually all cervical cancer and its immediate precursor lesions has clarified the key steps in cervical carcinogenesis: HPV acquisition, HPV persistence (vs clearance), progression to precancer, and invasion. This improved understanding of cervical carcinogenesis has led to the discovery of new diagnostic biomarkers that can be used to improve patient management in cervical cancer screening programs. Just as adjunctive HPV DNA testing can clarify the meaning of an equivocal Papanicolaou result (ie, atypical squamous cell of undetermined significance) by differentiating those at high and low risk of cervical precancer and cancer, the use of p16INK4a immunohistochemistry (p16 IHC) might be used to clarify ambiguous histologic diagnoses, specifically cervical intraepithelial neoplasia grade 2 (CIN2), which is now a recommendation from the Lower Anogenital Squamous Terminology Project. The use of p16 IHC can potentially distinguish those CIN2 that may be precancerous and need immediate excisional treatment from those who do not and can be managed less aggressively, thereby reducing the treatment of CIN2 by 25% to 30% or more.However, there are several challenges in the implementation of p16 IHC that must be addressed, including (1) overuse, which can lead to unnecessary laboratory costs and create further clinical uncertainty with respect to patient management; (2) the potential for diagnostic drift; and (3) appropriate annotation of the diagnosis to permit the less invasive management of young women with CIN2. Monitoring of the implementation of p16 IHC in routine practice will be useful to ensure its appropriate use and to measure the benefit to the patients.

Original languageEnglish (US)
Pages (from-to)154-157
Number of pages4
JournalPathology Case Reviews
Volume18
Issue number4
DOIs
StatePublished - Jul 2013
Externally publishedYes

Fingerprint

Cervical Intraepithelial Neoplasia
Immunohistochemistry
Uterine Cervical Neoplasms
Neoplasms
Carcinogenesis
Early Detection of Cancer
Terminology
Uncertainty
Biomarkers
Genotype
Costs and Cost Analysis
DNA
Therapeutics
Infection

Keywords

  • Cervical neoplasia
  • LAST
  • p16 IHC

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

A LASTing impression : Incorporating p16 immunohistochemistry into routine diagnosis of cervical neoplasia. / Castle, Philip E.

In: Pathology Case Reviews, Vol. 18, No. 4, 07.2013, p. 154-157.

Research output: Contribution to journalReview article

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