Page 118 - Strategies for non-invasive managementof high-grade cervical intraepithelial neoplasia - prognostic biomarkers and immunotherapy Margot Maria Koeneman

Chapter 6
we selected from this database all patients with a pure CIN2 diagnosis, who were hrHPV positive. Observational management of CIN 2 consisted of serial Papanicolaou (PAP) tests after 6, 12, and 24 months. A new colposcopy was planned in case of PAP 3a2 (cytological high-grade squamous intraepithelial lesion) or higher at either of the follow-up visits.
Pathological assessment
All baseline biopsies were intitially assessed by a gynecopathologist in routine diagnostics. After case selection all biopsies were reassessed by a second gynecopathologist, with the aim to select those lesions with exclusively CIN2 (and not CIN1-2). In case of discrepancies with the primary routine diagnosis, a third gynecopathologist reviewed the case, after which a consensus diagnosis was made between the second and third gynecopathologist. The histopathological assessment of cervical biopsies was performed according to national guidelines, based on the World Health Organization criteria, and was based on hematoxylin and eosin staining (figure 1), with additional p16 and KI67 staining. p16 (DAKO clone MX007) and KI67 (DAKO clone MIB1) staining were done via DAKO Autostainer. Strong P16 positivity was determined by strong and diffuse en block staining (figure 2). Weak p16 staining was anything other than negativity. KI67 expression was considered low (non or sporadic expression of cells) or high (more than sporadic, figure 3).
Figure 1: HE staining
Haematoxylin eosin stained FFPE slide of CIN2 lesion. The lesion shows basal and suprabasal atypia and mitotic activity of the squamous epithelium with a koilocytic overlay.
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