p16 expression in uterine cervical lesions and its role as diagnostic markers and clinical management

Abstract

Background: Cervical cancer is one of the world’s third most common gynecologic malignant tumors, especially in developing countries. This cancer is the most common cause of cancer-related death. High-risk human papillomavirus (HPV) is the main cause. p16 is a biological marker that can be used as a surrogate marker to increase diagnostic agreement for high-risk HPV infection. This study proved the differences in p16 expression in various age groups in low-grade cervical intraepithelial neoplasm (CIN), high-grade CIN, and squamous cell carcinoma (SCC). Methods: The research design was a cross-sectional analytic observational study, with a total sample of 40, taken from biopsy and surgery specimen patients diagnosed with CIN and SCC whose tissues were examined at the Anatomical Pathology Laboratory Faculty of Medicine Universitas Udayana/ Prof. dr. I G.N.G. Ngoerah General Hospital Denpasar. Histopathological diagnosis and determination of the type of cervical lesion were performed by Hematoxylin and Eosin (H&E) staining. p16 expression was evaluated by immunohistochemistry. The results were analyzed using the chi-square test to prove differences in p16 expression in various age groups and the Kruskal-Wallis Test followed by the Mann-Whitney Test to prove differences in p16 expression in low-grade CIN, high-grade CIN and SCC, with a significance level of p < 0.05. Results: The mean age of low-grade CIN was younger than high-grade CIN, which was 45.5±8.44 compared to 46.1±9.11. The mean age of low-grade and high-grade CIN is also younger than the mean age of SCC, which is 50.9±10.80. There was no significant difference in the expression of p16 in low grade CIN (p=0.34), high-grade CIN (p=0.45) and SCC (p=0.28) in various age groups. The expression of p16 was found significantly differ in all groups (p=0.011). Low-grade CIN significantly differed from high grade CIN (p=0.012) and SCC (p=0.008). However, we found same p16 expression in high-grade CIN and SCC (p = 0.866). Conclusion: p16 can be used as a screening method for diagnostic markers of high-risk HPV infection and a reference for planning therapy.