Cervical cancer is one of the most common cancer in women worldwide, and developing countries accounts for approximately 80% of cases occur. Pulmonary metastasis was reported to occur in 3.1% to 8.2% of patients with cervical carcinoma. Human Papilloma Virus (HPV) induced carcinogenesis signatures can be detected in more than 95% of cases. Overexpression of p16 as a surrogate marker well established in various HPV-related malignancies. As lung is the most common distant metastatic site in carcinoma cervix, distinguishing it from primary pulmonary malignancies is paramount importance in management. This study evaluates the diagnostic potential of p16 in the evaluation of pulmonary metastasis from cervix cancer.
Formalin-fixed, paraffin-embedded biopsy specimens of primary cervix cancer(n = 68), the primary squamous cell ca lung (n = 32) and pulmonary metastasis from the cervix (n = 22) analysed using automated Ventana immunohistochemical platform (Ventana Medical Systems, Tucson, AZ). Nuclear or cytoplasmic p16 staining score calculated as follows: negative for fewer than 10%; positive for >10% reactive.
Overexpression of p16 seen in 65/68 [95.5%] primary cervical biopsies Only two cases of primary squamous cell carcinoma lung showed p16 reactivity. Among the cases of metastatic cervix carcinoma to lung 18/22 (81.8) are positive for p16 immunoreactivity.Table: 295P
p16 immunoexpression in various tissue type
|Tissue of origin||P16 10% Positive|
|Primary Squamous cell carcinoma cervix (n = 68)||3||65|
|Primary squamous cell carcimona lung (n = 32)||30||2|
|Pulmonary metastasis from cervical squamous cell carcinoma (n = 22)||4||18|
This study evaluated the usefulness of p16 immunoreactivity in pulmonary metastasis evaluation. The HPV-driven carcinogenesis pathway of cervix cancer preserved even at the metastatic site. With a cut-off of 10% the sensitivity and specificity of p16 is 81.82% and 93.75% respectively.
Clinical trial identification
Legal entity responsible for the study
Chandan Krushna Das
All authors have declared no conflicts of interest.