Fig. 9.1
An example of cells from a high-grade squamous intraepithelial lesion from the same specimen: (a) Papanicolaou stain; (b) p16 immunocytochemical stain showing both nuclear and cytoplasmic staining. The presence of p16-positive cells is predictive of a precancerous lesion and may be useful in the screening and triage of cytologic specimens. (LBP, SurePath)
Fig. 9.2
An immunocytochemical stain for p16 and Ki67 performed together on the same slide (dual stain): p16 stains both the cytoplasm and nucleus (brown), and Ki67 stains the nucleus (red). Cells that show combined staining are a strong predictor of the presence of a high-grade squamous intraepithelial lesion. (LBP, ThinPrep)
It should be noted that as of this writing, none of the abovementioned immunocytochemical tests have been approved by the FDA for any of the uses noted. Therefore, any such use of these markers would require substantial validation in the user’s laboratory prior to clinical implementation.
9.3.1 Reporting of Molecular/Immunochemical and Cytologic Results
It is preferable for cytology and adjunctive test results to be reported concurrently to facilitate communication and record keeping. In addition, correlation of morphologic and adjunctive test results can be a valuable tool for pathology education and ongoing quality assurance. However, not all clinical practice settings allow for integrated reporting of cytology and molecular results. If integrated reporting is not feasible, then the report for each type of result should refer to the concurrent pending or previous report of the other test when possible.
9.3.2 Sample Report for Adjunctive Immunocytochemical Result
Adequacy:Satisfactory for interpretation
General categorization:Epithelial cell abnormality, squamous cell
Interpretation:Atypical squamous cells – undetermined significance
Note: Immunocytochemical stains for p16 and Ki67 (performed in combination) show dual-stained positive cells.
Comment: The combination of p16 and Ki67 dual staining has been shown to correlate to the presence of HSIL in subsequent biopsy specimens.
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Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol. 2012;137:516–42.CrossRefPubMed
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