Efetividade da marcação combinada de p16 e ki67 na referência de mulheres com citologia asc-us ou lsil para colposcopia

Abstract

Objective: To access p16/Ki-67 double staining (DS) in cervical cells performance for detecting precursor lesions of cervical cancer, in comparison to immediate repetition of the liquid-based cervical cytology (LBCC) in women with screening cytology results of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL). Methodology: This study recruited 121 women in primary health care units in Palmas and Porto Nacional, Tocantins, and in Rio de Janeiro, Brazil, with screening cytology showing ASC-US or LSIL. Women were addressed to the Cervical Referral Services (SRC) in each state and examined with colposcopy, LBCC and DS-p16/Ki-67. Histological results were available for women in which a cervical biopsy was obtained during initial evaluation or duringa follow-up up to 12 months, discerning cases with precursor lesions (CIN2 or CIN3) or not. Results: From the 121 recruited women, 76 screened positive in at least one exam (LBCC or DS-p16/Ki-67) and had a diagnostic conclusion. From these, 42 and 34 patients had previous ASC-US and LSIL exams, respectively. Most patients (86,8%) were within the recommended age group for screening in Brazil (25 to 64 years-old). CIN2-3 were found in 8 women (10,5%). DS-p16/Ki-67 identified a greater number of women with CIN2-3, addressing 50% of the women to colposcopy, but failing to detect these lesions in 50% of cases. DS-p16/Ki-67 was2,5x more sensitive than the immediate repetition of the LBCC. Conclusion: DS-p16/Ki-67 is more efficient to identify women with precursor lesions with screening cytopalotogical ASC-US or LSIL results, and without relevant increase in referring patients to colposcopy, in comparison to immediate repetition of the LBCC.