title: Role of p16, CK17, p63, and human papillomavirus in diagnosis of cervical intraepithelial neoplasia and distinction from its mimics.
abstract: BACKGROUND
  Diagnosis of cervical intraepithelial neoplasia (CIN), the precursor forms of cervical cancer, can be tricky and it has led to discrepancy between pathologists in distinguishing them from its mimics such as atypical immature metaplasia (AIM), immature squamous metaplasia (ISM), reactive atypia (RA), atrophy, and basal cell hyperplasia (BCH). To overcome this problem this study aims at using immunohistochemical (IHC) markers p16, p63, CK17, and human papillomavirus (HPV) to differentiate CIN from its mimics.
  
  
  METHODS
  This study analyzed 350 cervical samples with histomorphological diagnosis of CIN and its mimics and the utility of IHC markers p16, p63, CK17, and HPV in distinction was analyzed.
  
  
  RESULTS
  p16 showed 67.76% sensitivity and 99.4% specificity whereas HPV showed 57.9% sensitivity and 91.6% specificity in detecting CIN. CK17 and p63 did not show any significance in distinguishing CIN from its mimics. After IHC of AIM cases, 66.7% were reclassified as CIN III, 27.8% as ISM with reactive atypia (ISMRA), and 5.5% case as immature condyloma. In total, 3.7% of diagnosis was upgraded to CIN and 0.6% of pre-IHC diagnosis was downgraded from CIN to reactive lesions.
  
  
  CONCLUSIONS
  IHC panel comprising p16, p63, CK17, and HPV are useful adjuncts in distinguishing CIN from its mimics particularly when histomorphology has overlapping morphological features.
authors.affiliation: 1Jawaharlal Institute of Medical Education and Research (JIPMER), Puducherry, India.
authors.forename: Kalaivani
authors.initials: K
authors.lastname: Selvi
authors.forename: Bhawana Ashok
authors.initials: BA
authors.lastname: Badhe
authors.forename: Dasari
authors.initials: D
authors.lastname: Papa
authors.forename: Rajesh Nachiappa
authors.initials: RN
authors.lastname: Ganesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000032:analysis / Q000096:biosynthesis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053537:Keratin-17 / Q000032:analysis / Q000096:biosynthesis; D008565:Membrane Proteins / Q000032:analysis / Q000096:biosynthesis; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000821:virology
chemical_list: D014408:Biomarkers, Tumor; C081876:CKAP4 protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D053537:Keratin-17; D008565:Membrane Proteins
keywords: CK17; cervical intraepithelial neoplasm; human papillomavirus (HPV); p16; p63