P16 on cervix bx

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Patho2009

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Transformation zone histomorphologically shows immature squamous metaplasia with reactive/regeneretaive atypia (intraepithelial inflammatory cells are noted). P16 is performed and it is diffusely and strongly positive.

Would you go for high-grade squamous cell dysplasia based on p16 staining despite the histomorphology that supports squamous metaplasia.

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Transformation zone histomorphologically shows immature squamous metaplasia with reactive/regeneretaive atypia (intraepithelial inflammatory cells are noted). P16 is performed and it is diffusely and strongly positive.

Would you go for high-grade squamous cell dysplasia based on p16 staining despite the histomorphology that supports squamous metaplasia.

You also have to order the MIB1 (Ki67) in tandem with the p16.
 
Was there any suspicion of CIN before performing p16?

I'm asking this because my understanding is that morphology is still considered the gold standard for diagnosis of CIN and using p16/Ki67 should be limited to cases where there is such suspicion.
 
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Agree with 2121115. Always gotta run the p16 with the ki-67. Always.
 
Ki67 stains the basal part while p16 staining is strong and diffuse. Results are contradicting.
 
Transformation zone histomorphologically shows immature squamous metaplasia with reactive/regeneretaive atypia (intraepithelial inflammatory cells are noted). P16 is performed and it is diffusely and strongly positive.

Congratulations! You have just inappropriately ordered an immunostain. If you are not going to act on the result don't order it. If the H&E is that convincing don't get yourself into trouble by ordering the stain. Many times stains like this work because their PPV is influenced by the likelihood that it is what it is based on the H&E (i.e. an increased "incidence" of it being dysplasia when it looks like dysplasia on H&E but just not 100% sure versus a decreased "incidence" when it looks dead negative but you are ordering the stain to convince yourself the opposite way). When you order the stain willy-nilly outside of that "increased incidence" the PPV decreases. Always ask yourself "What am I going to do with a positive result and what am I going to do with a negative result" before you order any immunostain (or any test for that matter).
 
Congratulations! You have just inappropriately ordered an immunostain. If you are not going to act on the result don't order it. If the H&E is that convincing don't get yourself into trouble by ordering the stain. Many times stains like this work because their PPV is influenced by the likelihood that it is what it is based on the H&E (i.e. an increased "incidence" of it being dysplasia when it looks like dysplasia on H&E but just not 100% sure versus a decreased "incidence" when it looks dead negative but you are ordering the stain to convince yourself the opposite way). When you order the stain willy-nilly outside of that "increased incidence" the PPV decreases. Always ask yourself "What am I going to do with a positive result and what am I going to do with a negative result" before you order any immunostain (or any test for that matter).

Note, however that there was a recent article http://www.ncbi.nlm.nih.gov/pubmed/20924035 which states that p16 should be routinely performed (or even performed instead of H&E) on all cervical biopsies. Amazingly enough, I don't think this study was done by a reference lab.
 
Ki67 stains the basal part while p16 staining is strong and diffuse. Results are contradicting.

You could do in situ hybridization for 16, 18 and HR. Or equivocate and describe the H&E but say the p16 was confounding and they'll probably follow her closely. How did it end up getting signed out? BTW, why was the p16/Ki ordered in the first place? What was the pap and did they do HR HPV PCR?
 
I sent it for outside consultation. The outside expert's opinion favored severe squamous cell dysplasia. Although not convinced, I just scanned his report, attached it to my report and wrote an addendum (please refer to the outside consultation report -Note that the report reflects the outside consultant opinion only)!.
 
Ki67 stains the basal part while p16 staining is strong and diffuse. Results are contradicting.

Well, even though the intensity and pattern of p16 staining used to be considered akin to grades of dysplasia (e.g., lower third = CIN 1, full thickness = CIN 3, etc.) I have tossed this concept out with the baby and bathwater and all. Not knowing the H&E morphology and prior cytologic findings, low/basal ki-67+ in conjunction with strong and diffuse p16+ suggests a low-grade lesion secondary to integration of a HR HPV type.
 
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