Histomorphological spectrum of small cervical biopsies with p16 staining in pre invasive lesions: A seven year retrospective analysis

Abstract

I ntroduction: Uterine cervix is a common site for many neoplastic and non-neoplastic lesions. Nonneoplastic\xa0lesions include acute and chronic cervicitis, hyperplasia, polyps and cysts. Neoplastic lesions\xa0include pre invasive lesions and cervical cancer. Cervical cancer is the second most common cancer in Indian women after breast cancer. Histo pathological studies of cervical lesions helps in early diagnosis\xa0and proper management of patients. Various biomarkers are available for diagnosis of HPV in pre invasive\xa0lesions of cervix. Aims : To analyse the histo pathological spectrum of cervical lesions and their relation with demographics\xa0and clinical presentation in small cervical biopsies. Our aim was also to study the role of p16\xa0immunohistochemistry on a small subset of pre invasive lesions of cervix. Materials and Methods : This is a hospital based seven year retrospective study of 279 cervical punch\xa0biopsies performed on patients from January 2013 to December 2019. Clinical history, demographic\xa0details, histopathology (H&E) slides and reports of cervical punch biopsies of the patients were retrieved from past records and analyzed. Six cases of pre invasive lesions of cervix were studied using p16\xa0immunohistochemistry. Results : The age range of various cervical lesions was 21 to 70 years with a mean age of 45.5 years. The\xa0most common age group affected in non- neoplastic lesions was 30-40 years and among neoplastic lesions\xa0it was found to be in 40 to 50 years.\xa0White discharge per vaginum was the most common complaint seen in122 (43.7%) cases, followed by\xa0backache in 50 (17.9%), abdominal pain in 37 (13.2%). Bleeding per vaginum was noted in 60 (21.5%) cases and post coital bleeding was reported in 10 cases (3.5%)\xa0On histopathological examination, 163 cases (58.4%) were non-neoplastic, 68 (24.37%) were pre-invasive\xa0and 48 (17.2%) cases were malignant. The most common non-neoplastic lesion was endocervical polyp reported in 90 biopsies. Among neoplastic\xa0cases, LSIL was seen in 30 (12.1%) HSIL in 37 (13.5%) and condyloma in 1 case (0.35%). Squamous cell\xa0carcinoma was diagnosed in 44 cases (15.2%). Adenocarcinoma was seen only in 4 cases (1.4%).\xa0The percentage positivity of p16 staining on six biopsies, was 33.3% in LSIL and 66.6% in cases of HSIL.\xa0Invasive squamous cell carcinoma was taken as a positive control. Conclusion : Histopathological diagnosis of cervical punch biopsy is a valuable tool in early diagnosis\xa0of neoplastic, pre-invasive and non-neoplastic lesions of cervix.Immunostaining with p16 can be a useful\xa0adjunct to routine histopathology in diagnosis of preinvasive lesions of cervix. Keywords:\xa0 Cervical biopsy,\xa0Cervicitis,\xa0Koiliocytosis,\xa0Preinvasive lesions,\xa0Carcinoma cervix,\xa0p16,\xa0HPV.