ASSESSING PROGRESSION OF CERVICAL PRE-CANCER LESIONS

The purpose of this study was to accomplish a comparative assessment between the immune histochemical and the immunocytochemical expression of p16 protein and L1 major capsid protein of HPV respectively, in cervical squamous intraepithelial lesions with low and high grade, in order to determine, through morphological and clinical correlations, their applicability into practice when diagnosing and further monitoring the patients. There were 119 patients included in the study, having a mean age of 40, cytologically and histopathologically diagnosed in the Laboratory of Pathologic Anatomy of “Elena Doamna” Third Clinic of Obstetrics and Gynaecology in Iasi. 42 of these patients were diagnosed with LSIL (low grade squamous intraepithelial lesion) and 51 with HSIL (high grade squamous intraepithelial lesion). The cervical- vaginal smears were interpreted using the Papanicolaou method. The conventional smears were assessed for the immunoexpression of L1 capsid protein HPV, and the corresponding biopsies for p16 immunoexpression. The colouring pattern of p16 protein was predominantly nuclear, with an occasional cytoplasmic positivity. P16 biomarker was positive in cytological smear prepared in a liquid environment for 71.6% of the patients, without significant differences for those over 40 years old (69.6% vs 69.0%; p=0.887), with an increase in positivity from 54.8% in LSIL to 98% in HSIL (p=0.05); the oncogenic risk was 1,55 higher (RR=1.55; IC95%: 1.19÷2.01). L1 protein was detected in 34,5% of the patients, the expression tending to increase in parallel with the increase in the severity of the lesions (66.7% LSIL; 17.6% HSIL). The presence of L1 protein in the patients with an increased risk of malignant transformation of HPV seems to be a protective factor (RR=0.42; IC95%: 0.27÷0.66). The immunoexpression of L1 HPV protein has clinical applications in assessing the progression of cervical pre-cancer lesions. The analysis of p16 status, in parallel with the expression of L1 HPV protein, can be very useful in assessing the risk of progression for cervical intraepithelial squamous lesions. The preventive conduct supported by a primary care screening, leads to a decrease in the morbidity by pre-invasive lesions and an evolution with a favourable prognostic.