title: Diagnosing cervical biopsies in adolescents: the use of p16 immunohistochemistry to improve reliability and reproducibility.
abstract: OBJECTIVE
  To increase the specificity in diagnosing cervical biopsies in adolescents, we evaluated the use of p16 immunohistochemistry (IHC) as an adjuvant test in addition to hematoxylin and eosin (H&E).
  
  
  METHODS
  One hundred cervical histological tissues from adolescents were stained with routine H&E and monoclonal p16 (clone E6H4; dilution, 1:25; Dako). One gynecologic pathologist and 3 pediatric pathologists independently reviewed the cases, rendered diagnoses first by using H&E alone, and then added p16 IHC as an adjuvant marker. The interobserver agreement between the gynecologic pathologist and the pediatric pathologists was calculated using kappa statistics.
  
  
  RESULTS
  The agreement rates between the gynecologic pathologist and all 3 pediatric pathologists were fair (kappa = 0.39, 0.36, and 0.37) when only H&E sections were used, and were improved to moderate (kappa = 0.53, 0.44, and 0.50) after using p16 IHC in addition to H&E.
  
  
  CONCLUSIONS
  The evaluation of cervical intraepithelial neoplasia based solely on H&E-stained biopsies may lack interobserver reproducibility. The p16 IHC reduces the number of discrepancies and improves the rate of agreement among pathologists in diagnosing adolescent's cervical lesions. The improvement in the diagnosis of cervical biopsies has important implications in the treatment and follow-up of adolescent girls with abnormal cervical cytological diagnoses.
authors.affiliation: Departments of Pathology, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock, AK 72202, USA. sayedkadria@uams.edu
authors.forename: Kadria
authors.initials: K
authors.lastname: Sayed
authors.forename: Soheila
authors.initials: S
authors.lastname: Korourian
authors.forename: Dale A
authors.initials: DA
authors.lastname: Ellison
authors.forename: Karen
authors.initials: K
authors.lastname: Kozlowski
authors.forename: Lori
authors.initials: L
authors.lastname: Talley
authors.forename: Hazel V
authors.initials: HV
authors.lastname: Horn
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.forename: David M
authors.initials: DM
authors.lastname: Parham
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000378:metabolism*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015588:Observer Variation; D012680:Sensitivity and Specificity; D013194:Staining and Labeling; D002583:Uterine Cervical Neoplasms / Q000378:metabolism / Q000473:pathology*; D002578:Uterine Cervical Dysplasia / Q000378:metabolism / Q000473:pathology*
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16