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ArtigoDireito Autoral
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AN EVALUATION OF P16(INK4A) EXPRESSION IN CERVICAL INTRAEPITHELIAL NEOPLASIA SPECIMENS, INCLUDING WOMEN WITH HIV-1
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Although several studies have evaluated the role of p16INK4a as a diagnostic marker of cervical intraepithelial
neoplasia (CIN) and its association with disease progression, studies regarding the role of p16INK4a in human immunodeficiency virus (HIV)-infected patients remain scarce. The present study was designed to determine the potential utility of p16INK4a as a diagnostic marker for CIN and invasive cervical cancer in HIV-positive and negative
cervical specimens. An immunohistochemical analysis of p16INK4a was performed in 326 cervical tissue microarray
specimens. Performance indicators were calculated and compared using receiving operating characteristics curve
(ROC)/area under the curve. In HIV-1-negative women, the percentage of cells that was positive for p16INK4a expression was significantly correlated with the severity of CIN (p < 0.0001). A ROC curve with a cut-off value of 55.28%
resulted in a sensitivity of 89%, a specificity of 81%, a positive predictive value of 91% and a negative predictive
value of 78%. HIV-seropositive women exhibited decreased expression of p16INK4a in CIN2-3 specimens compared
with HIV-negative specimens (p = 0.031). The ROC data underscore the potential utility of p16INK4a under defined
conditions as a diagnostic marker for CIN 2-3 staging and invasive cervical cancer. HIV-1 infection, however, is
associated with relatively reduced p16INK4a expression in CIN 2-3.
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