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目的研究表皮生长因子受体(EGFR)、P16和Ki-67在子宫颈浸润性鳞状细胞癌(SCC)和鳞状上皮内瘤变(CIN)中的表达,探讨EGFR在宫颈SCC发生中的作用及在CIN诊断和分级中的价值。方法采用免疫组化EnVision法检测20例慢性宫颈炎、25例低级别CIN、25例高级别CIN和20例SCC中EGFR、P16和Ki-67的表达情况。结果慢性宫颈炎中EGFR表达阴性或仅少数基底层细胞阳性,随着宫颈病变程度的加重,EGFR在上皮层中的表达上移且阳性率增高。EGFR区分慢性宫颈炎和低级别CIN的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为12%、100%、100%和47.6%,与P16和Ki-67比较差异无显著性(P>0.05)。EGFR区分低级别CIN和高级别CIN的敏感性、特异性、PPV和NPV分别为64%、88%、84.2%和71%,敏感性和NPV均低于P16和Ki-67,且各组差异有统计学意义(P=0.002;P=0.002;P=0.018;P=0.008)。特异性(88%)和PPV(84.2%)均高于P16和Ki-67,但无统计学意义(P=0.157;P=0.702;P=0.725;P=1.000)。EGFR/P16联合检测在区分慢性宫颈炎和低级别CIN以及低级别CIN和高级别CIN中的敏感性、特异性、PPV和NPV均无显著性差异(P>0.05)。结论 EGFR在宫颈SCC的发生、发展中可能起着重要作用,EGFR与P16或Ki-67联合检测对宫颈CIN的诊断和分级有一定帮助。
Objective To study the expression of epidermal growth factor receptor (EGFR), P16 and Ki-67 in cervical invasive squamous cell carcinoma (SCC) and squamous intraepithelial neoplasia (CIN), and to explore the role of EGFR in the development of cervical SCC Role and value in the diagnosis and classification of CIN. Methods The expressions of EGFR, P16 and Ki-67 in 20 cases of chronic cervicitis, 25 cases of low grade CIN, 25 cases of high grade CIN and 20 cases of SCC were detected by EnVision immunohistochemistry. Results In chronic cervicitis, the expression of EGFR was negative or only a few basal cells were positive. With the severity of cervical lesions, the expression of EGFR in the epithelial layer was up-regulated and the positive rate was increased. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EGFR in differentiating chronic cervicitis from low-grade CIN were 12%, 100%, 100% and 47.6%, respectively, compared with P16 and Ki-67 There was no significant difference (P> 0.05). The sensitivity, specificity, PPV and NPV of EGFR differentiating between low-grade CIN and high-grade CIN were 64%, 88%, 84.2% and 71%, respectively. The sensitivity and NPV were lower than P16 and Ki-67, There was statistical significance (P = 0.002; P = 0.002; P = 0.018; P = 0.008). Specificity (88%) and PPV (84.2%) were higher than P16 and Ki-67, but not statistically significant (P = 0.157; P = 0.702; P = 0.725; P = 1.000). The sensitivity, specificity, PPV and NPV of EGFR / P16 combined detection in discriminating chronic cervicitis and low grade CIN from low grade CIN and high grade CIN were not significantly different (P> 0.05). Conclusion EGFR may play an important role in the occurrence and development of cervical SCC. The combination of EGFR and P16 or Ki-67 may be useful in the diagnosis and classification of cervical CIN.