Introduction of p16INK4a as a surrogate biomarker for HPV in women with invasive cervical cancer in Sudan

Hina Sarwath,Nazik Elmalaika Husain,Ali A Sultan,Shahinaz Bedri,Devendra Bansal,Mahmoud Mohamed

doi:10.1186/s13027-017-0159-0

Hina Sarwath, Nazik Elmalaika Husain + Show 4 more

Open Access

https://doi.org/10.1186/s13027-017-0159-0

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Abstract

BackgroundCervical cancer is the fourth most common cancer in women worldwide with highest incidence reported in Eastern Africa in 2012. The primary goal of this study was to study the expression of p16INK4a in squamous cell carcinoma (SCC) of the cervix by immunohistochemistry (IHC) and determine relation with clinico-pathological parameters. This study further explored the correlation of p16INK4a immunostaining with another proliferation marker, Ki-67 and to study if human papillomavirus (HPV) IHC can be used as a marker for detection of virus in high-grade dysplasia.MethodsA total of 90 samples, diagnosed for cervical cancer, were included in the study. Fixed Paraffin Embedded (FFPE) tissue sections were stained with anti-p16INK4a, anti-Ki-67 and anti-HPV antibodies using automated immunohistochemistry platform (ASLink 48-DAKO).ResultsImmunohistochemical protein expression of p16INK4a positivity was found to be highest in SCC (92.2%, n = 71) than other HPV tumors (76.9%, n = 10). The majority of cases (97.4%) were p16INK4a positive in the age group 41–60 years. In addition, a statistically significant difference between p16INK4a and HPV was observed among total cervical tumor cases and SCC cases.ConclusionsAs expected staining of invasive cervical cancer with anti-HPV showed rare positivity because HPV heralds active infection in dysplastic lesions and not of frank cervical carcinoma. In contrast, anti-p16INK4a IHC results showed positive correlation in SCC and other cervical tumors.

Highlights

Cervical cancer is the fourth most common cancer in women worldwide with highest incidence reported in Eastern Africa in 2012
Tumor grade, which is the histopathologic differentiation of cancerous tissue, Table 1 Demographic, clinico-pathological characteristics and frequency of different immunostaining profiles according to diagnosis among women from Sudan
Correlating p16INK4a expression with clinico-pathological parameters, we found that p16INK4a expression was directly proportional to the diagnosis of cervical tumors where 90.1% of squamous cell carcinoma (SCC) cases and 76.9% as Adenocarcinoma (AC) showed positive p16INK4a expression, which is in agreement with previous studies [15, 29, 30]

Summary

Introduction

Cervical cancer is the fourth most common cancer in women worldwide with highest incidence reported in Eastern Africa in 2012. The primary goal of this study was to study the expression of p16INK4a in squamous cell carcinoma (SCC) of the cervix by immunohistochemistry (IHC) and determine relation with clinico-pathological parameters. Cervical cancer continues to be a major public health problem in less developed regions of the world and ranked at fourth position among various cancers in women with estimated age standardized rates over 30 per 100, 000 women [1]. Global prevalence of cervical cancer is estimated 11.7%, out of which Sub-Saharan Africa was reported most affected region with highest prevalence rates (24%) [2]. Histomorphological types of cervical cancers include squamous cell carcinoma (SCC), adenocarcinomas and neuroendocrine carcinomas. SCC represents the majority of cases diagnosed (80%) while the remainder cases are adenocarcinomas and other types [12, 13]

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