The Importance of Ki-67, p16, C-erb-B2, and Cyclin D1 Expressions in LSIL, HSIL and Cervical Squamous Cell Carcinoma Biopsies

INTRODUCTION: The squamous cell carcinoma (SCC) of the cervix is the most common malignant tumor of gynecological cancers. Squamous intraepithelial lesions (SILs) are known as a preinvasive lesion. Due to problems in the grading of these lesions that are effective in the development of cervical cancer, immunohistochemical markers are reported to be useful in the differentiation of lesions. In this study, the expression and intensity of the staining pattern of Ki-67, p16, cyclin D1, and c-erb- B2 in HSIL and LSIL cases were investigated.
METHODS: 40 patients with SCC, 40 patients with low grade SIL (LSIL), and 40 patients with high grade SIL (HSIL) who were diagnosed in Department of Pathology of XXX University Medical Faculty between 2003-2011 years were included in this study. C-erb-B2, Ki-67, p16, and cyclin D1 expressions was investigated in the preparations of the patients.
RESULTS: C-erb-B2 in 4 cases with SCC (10%), in 6 cases with HSIL (15%), and in 2 cases with LSIL (5%) showed positive staining. There was no statistically significant difference between the three groups (p>0.05). However, in cases with SCC, a strong correlation between c-erb-B2 and the disease stage was observed (p<0.05, r = 0.891). Ki-67 expression was present in average 20% of LSIL cases, average 35% of cases of HSIL, and average 40% of SCC cases. The difference between groups was statistically significant (p<0.05) and due to LSIL. Nuclear staining of cyclin D1 was mainly observed in cases with LSIL, however, cytoplasmic staining was mainly observed in cases with HSIL and SCC. No statistically significant difference between groups was observed with cyclin D1 (p>0.05). p16 expression was found in 39 (97.5%) cases with HSIL, 12 cases (30%) with LSIL. The difference was statistically significant (p<0.05).
DISCUSSION AND CONCLUSION: In conclusion, c-erb-B2 and cyclin D1 expression is not useful in the differentiation of these lesions. However, the Ki-67 may be used to separate LSIL from HSIL and SCC. Also, p16 expression was concluded to be useful in the differentiation of HSIL and LSIL.