The histopathologic interpretation of cervical intraepithelial neoplasia (CIN) is subject to a high level of interobserver variability and a substantial number of false−positive and false−negative results. We assessed the impact of the conjunctive interpretation of p16(INK4a)−immunostained slides on the accuracy of community−based pathologists in diagnosing high−grade cervical intraepithelial neoplasia (CIN; CIN 2 and CIN 3) in biopsy specimens. Twelve pathologists rendered independent diagnoses on a set of 500 H&E−stained cervical punch and conization specimens. Results were compared with a dichotomized "gold standard" established by consensus of 3 gynecopathology experts. When p16(INK4a)−immunostained slides were added and conjunctively interpreted with the H&E−stained slides, a significant increase in diagnostic accuracy for the detection of high−grade CIN was observed (P = .0004). Sensitivity for high−grade CIN was increased by 13%, cutting the rate of false−negative results in half. Agreement of community−based pathologists in diagnosing high−grade CIN was significantly improved (mean kappa values advanced from 0.566 to 0.749; P < .0001). Reproducibility of p16(INK4a) stain interpretation was excellent (kappa = 0.899). Our results show that conjunctive interpretation of p16(INK4a)−stained slides could significantly improve the routine interpretation of cervical histopathology.

PMID: 20154278 [PubMed − indexed for MEDLINE] Source: National Library of Medicine.