P16/KI67 DOUBLE STAINING RESULTS IN WOMEN WITH DIFFERENT TYPES OF DISPLASIA BASED ON PAP-TEST RESULTS IN GEORGIA

Carcinoma  of the uterine cervix is the second  most common neoplasm among women worldwide, and it is the fifth leading cause of all cancer-related death. 1 Cervical cancer is caused by a persistent infection with high-risk human human papillomavirus (HR-HPV) types. 2 Although almost all carcinomas of the uterine cervix are derived from intraepithelial neoplasias, 3, 4 only a minority of these lesions progress to cervical cancer. 4,5 High grade squamous intraepithelial lesions (HSIL), which include cervical intraepithelial neoplasia grades 2 and 3 (CIN2-3), are considered the immediate precursors to cervical cancer , because of the relatively high risk of them developing  them into cervical carcinoma. 2,4 Cervical cancer prevention programs has effectively reduced the burden and mortality owing to cervical cancer where it has been effectively implemented. 6,7,8 Although the conventional Pap smear has its value, it is nevertheless hampered by a relatively low sensitivity and specificity 9,10 and beyond that a high interobserver variability. 10, 11 During past years the liquid-based cytology (LBC) has lead to improved diagnostics. 12 Still, cervical cytological screening relies on subjective morphologic methods and might be associated with sampling error and interpretation bias. 9 There is substantial number of ASC-US/LSIL morphologic findings for which no high-grade cervical intraepithelial neoplasia  (HGCIN) can be confirmed on histological specimens collected during subsequent colposccopy-guided biopsy sampling. 13,14,15 Adoption into clinical practice of testing for the detection of HR-HPV to cytology for cervical cancer screening in women with ASCU-US/LSIL group has limitation, especially in terms of specificity. 15 Most HPV infections are transient. 16 The effectiveness of triaging ASC-US/LSIL cases with HPV testing is variable, depending on the patients age and socioeconomic factors. 15,17,18 Recent studies have shown, that existent cytological screening recognizes mostly transient lesions, whose investigation  and  treatment do not benefit the patient 19 and in young woman may increase risk for premature rapture of membranes and preterm delivery 20,21 Thus it is important to implement methods, that is biomarker-base and add objectivity to the evaluation of the cervicocytological slides.