Comparison of the sensitivity and specificity of p16/Ki-67 dual staining and HPV DNA testing of abnormal cervical cytology in the detection of histology proven cervical intraepithelial neoplasia grade 2 and above (CIN 2+)

Introduction: Human papillomavirus (HPV) testing is used as a means of triaging cervico-vaginalsmears with low grade squamous abnormalities or as part of co-testing with cytology. While HPVtesting has a high sensitivity, it has a low specificity in detecting cervical intraepithelial neoplasiagrade 2 and above (CIN 2+) leading to unnecessary colposcopy referrals. We investigate the accuracyof the p16/Ki-67 dual immunocytochemical stain in determining the presence of CIN 2+ lesions onhistology and its potential as a superior biomarker for triage. Methods: Liquid based cervico-vaginalcytology specimens with squamous abnormalities and corresponding histology from 97 women withsubsequent colposcopy and biopsy were included. The specimens were then subjected to the dual stainand Roche Cobas 4800 multiplex real time PCR HPV DNA testing. The sensitivity and specificity ofthe dual stain and HPV testing were calculated using CIN 2+ on histology as a reference standard.Results: The sensitivity and specificity of the dual stain in detecting histology proven CIN 2+ was93.7% and 76.5% while HPV testing was 85.7% and 14.7% respectively. Of the 44 women withASCUS or LSIL on cytology, the dual stain also reduced the number of unnecessary colposcopyreferrals from 27 to 7 when used as a triage marker compared to HPV testing. Conclusion: p16/Ki-67dual stain was more sensitive and specific than HPV testing in determining the presence of CIN 2+on histology. It could triage low grade cervico-vaginal specimens more effectively and potentiallyhelp women avoid unnecessary colposcopies. Future studies are needed to further evaluate its rolein cervical cancer screening programmes.

Syndecan-1 is a potential biomarker for triple-positive breast carcinomas in Asian women with correlation to survival

<p><b>INTRODUCTION</b>While overexpression of syndecan-1 has been associated with aggressive breast cancer in the Caucasian population, the expression pattern of syndecan-1 in Asian women remains unclear. Triple-positive breast carcinoma, in particular, is a unique subtype that has not been extensively studied. We aimed to evaluate the role of syndecan-1 as a potential biomarker and prognostic factor for triple-positive breast carcinoma in Asian women.</p><p><b>METHODS</b>Using immunohistochemistry, staining scores of 61 triple‑positive breast carcinoma specimens were correlated with patients' clinicopathological variables such as age, ethnicity, tumour size, histological grade, lymph node status, lymphovascular invasion, associated ductal carcinoma in situ grade, recurrence and overall survival.</p><p><b>RESULTS</b>Syndecan-1 had intense staining scores in triple‑positive invasive ductal breast carcinomas when compared to normal breast tissue. On multivariate analysis, syndecan-1 epithelial total percentage and immunoreactivity score showed statistical correlation with survival (p = 0.02).</p><p><b>CONCLUSION</b>The intense staining scores of syndecan-1 and their correlation with overall survival in patients with triple-positive breast carcinoma suggest that syndecan-1 may have a role as a biological and prognostic marker in patients with this specific subtype of breast cancer.</p>

Comparative study of fine needle aspiration cytology and histopathology in diagnosis of superficial lymphadenopathies

A series of (100) enlarged superficial lymph nodes involving cervical, submandibular, supraclavicular and axillary regions was examined by fine needle aspiration cytology (FNAC). The results of FNAC were compared with histological results. Three smears were inadequate for study and excluded from data analysis. Of the remaining (97), (50) were cytologically benigan and (47) were malignant including (42) cases of metastatic tumor and (5) of malignant lympho-mas. (97 percent) sensitvity, (100 percent) specificity, (3 percent) false negative, false positive and (98 percent) accuarcy for FNAC of enlarged lymph nodes were statistically analyzed from this study. A good discrimination could be made between benign and malignant lesions. However, FNAC cannot be used as specific tool to differentiate the various benign lesions. The diagnosis of metastatic malignancy of lymph nodes would have been definitely obtained by cytology with high accuracy without the need for biopsy. This simple, reliable, inexpensive techniques would be of immense benefit in diagnosis of metastatic carcinoma in superficial lymphadenopathies. However, the cytological evaluation of the type of metastasis would not always be possible even upon re-examination of the smear.