p16 Staining of Cervical Biopsies May Decrease the Frequency of Unnecessary Loop Electrosurgical Excision Procedures

Area of Science:

• Gynecologic Pathology
• Cervical Cancer Screening
• Diagnostic Accuracy

Background:

• Loop electrosurgical excision procedures (LEEPs) for high-grade cervical intraepithelial neoplasia (CIN 2+) are negative in 14-24% of cases.
• Diagnostic errors or biopsy-related regression may explain negative LEEP outcomes.
• p16 immunohistochemical staining improves cervical biopsy diagnostic accuracy.

Purpose of the Study:

• To investigate if p16-based cervical biopsy diagnoses reduce the frequency of negative LEEPs.
• To evaluate the impact of p16 staining on LEEP outcomes for CIN 2+.

Main Methods:

• Retrospective cross-sectional study of 593 patients undergoing LEEP for CIN 2+ (2002-2012).
• Review of colposcopic biopsies and LEEPs, with p16 immunostaining performed.
• Analysis of data using chi-squared and regression modeling, comparing pre- and post-p16 implementation eras.

Main Results:

• The frequency of negative LEEPs decreased from 10% (12/126) before 2006 to 5% (23/467) during the p16 era (2006-2012).
• An inverse relationship was observed between p16 use and negative LEEP frequency (R = 0.71; p < .001).
• This association was independent of potential covariates.

Conclusions:

• More accurate p16-based diagnoses appear to reduce the frequency of unnecessary LEEPs.
• p16 staining is a valuable tool for improving diagnostic accuracy in cervical precancer management.