Abstract:
BACKGROUND : Cervical carcinoma was the second leading malignancy in South African women (following breast carcinoma)
in 2010. This study aimed to correlate histopathological criteria and immunohistochemical stains in terms of the grading of
cervical intraepithelial precursor lesions and evaluate intra- and inter-observer variability with only histology and with additional
immunohistochemical stains.
METHODS : Archival tissue from large-loop excision of the transformation zone (LLETZ) was graded on two separate occasions
by an independent observer in terms of lesional severity. The section with the highest grade precursor lesion was selected
and submitted for immunohistochemical stains that included p16 and Ki-67. These stains were also evaluated on two separate
occasions by an independent observer.
RESULTS : This study showed kappa values of 0.47 and 0.46 respectively for the separate histological evaluations of the observer
and the original pathology report. The kappa value for the two evaluations of the observer was 0.57. Thus inter- and intraobserver
variability is fair with the use of routinely stained histological slides. The two Ki-67 assessments had a kappa value of
0.85 and the p16 had a value of 0.80. Intra-observer agreement was markedly higher when using immunohistochemistry.
CONCLUSION : Although in most cases of precursor lesions of the cervix the grading can be made on routinely stained sections,
intra- and inter-observer variability remains high. Immunohistochemical markers reduce this variability and aid in deciding in
which group to place ambiguous lesions.
