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Federación Mexicana de Ginecología y Obstetricia, A.C.

2021, Número 04

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Ginecol Obstet Mex 2021; 89 (04)


Reclasificación de las lesiones intraepiteliales escamosas de alto grado (NIC2) del cuello uterino con el marcador p16

Barrios L, Becerra D, Benedetti I

Idioma: Español
Referencias bibliográficas: 53
Paginas: 286-298
Archivo PDF: 348.53 Kb.


RESUMEN

Objetivo: Reclasificar biopsias de cuello uterino con LIE-AG-NIC2 utilizando hematoxilina eosina y p16, estimar la asociación de la clasificación errada con el factor de riesgo edad y determinar el desempeño diagnóstico de p16 para definir la existencia de LIE-AG.
Materiales y Métodos: Estudio prospectivo, de serie de casos, llevado a cabo en la Facultad de Medicina de la Universidad de Cartagena, Colombia. Se incluyeron biopsias de cuello uterino diagnosticadas durante un año con LIE-AG-NIC2. Se incluyeron casos con seguimiento (cono o histerectomía) y se excluyeron los que no tenían tejido archivado. La expresión de p16 se determinó mediante inmunohistoquímica. Los reclasificaron dos patólogos en dos grupos (≤LIE-BG/≤NIC1 y LIE-AG/≥NIC2) aplicando hematoxilina eosina y p16. Para la reclasificación con p16 se aplicaron χ2 y prueba de Fisher y para hematoxilina eosina se tomó p16 como referencia. Se obtuvo la proporción de muestras reclasificadas y la OR de la relación de éstas con los grupos etarios (menos de 30 años y más o menos mayores de 30 años).
Resultados: Se incluyeron 39 casos. De los estudios de seguimiento, 10 de 39 resultaron negativos para LIE-AG/≥NIC2. Dieciocho de los 39 casos evaluados con p16 se reclasificaron en ≤LIE-BG/ ≤NIC1, de estos 10 correspondieron a menores de 30 años. 15 de los 18 casos reclasificados como LIE-AG/≥NIC2 pertenecían a pacientes ≥ 30 años (OR = 0.368, IC95%: -1.53). La concordancia interobservador para determinar resultado ≥ NIC2 con hematoxilina eosina fue pobre, y con p16 fue moderado.
Conclusiones: La evaluación de las biopsias de cuello uterino con el marcador p16, junto con hematoxilina eosina, tiene mayor reproducibilidad diagnóstica que solo utilizando hematoxilina eosina, que aumenta la concordancia interobservador y reduce el tratamiento innecesario, sobre todo en mujeres menores de 30 años.


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