p16 Immunohistochemistry Improves Treatment Decision-Making in See-and-Treat Management of Cervical Intraepithelial Neoplasia

Open Access

Abstract

Background: The “see-and-treat” approach is commonly used in cervical cancer prevention programs to reduce loss to follow-up by providing immediate treatment after colposcopic diagnosis. However, discrepancies between colposcopic impressions and histopathological findings may affect treatment decision-making. p16 immunohistochemistry has emerged as a biomarker associated with oncogenic human papillomavirus–induced cellular transformation and may improve diagnostic accuracy. This study evaluated the association between p16 expression and clinicopathological characteristics and examined its implications for treatment decision-making in the management of cervical intraepithelial neoplasia (CIN). Methods & Materials: This cross-sectional study included 72 women aged 30-60 years diagnosed with high-grade lesions on colposcopy using the Swede scoring system attending the colposcopy clinic of Bangladesh Medical University (BMU), Shahbagh, Dhaka in 2022-2023. All participants underwent colposcopy-guided cervical biopsy followed by histopathological examination. Histological diagnoses were categorized as CIN I, CIN II, CIN III, or benign lesions such as chronic cervicitis. p16 immunohistochemistry staining was performed and interpreted as diffuse/block positivity, focal staining, or negative expression. Treatment modalities and treatment adequacy were analyzed. Results: Histopathology revealed CIN I in 29.2%, CIN II in 23.6%, CIN III in 33.3%, and chronic cervicitis in 13.9% of cases. Overall, 43.1% of colposcopic high-grade lesions were not confirmed as high-grade on histology, indicating potential overtreatment risk in a see-and-treat setting. Diffuse p16 positivity was observed in 52.7% of cases. Overtreatment occurred in 13.9% of patients and was exclusively associated with p16-negative lesions, whereas undertreatment occurred in 22.2% of cases and was observed only among p16-positive lesions (p < 0.001). Conclusion: Substantial discordance exists between colposcopic impressions and histopathological findings. p16 immunohistochemistry may improve treatment decision-making in see-and-treat management by helping identify lesions requiring definitive treatment while avoiding unnecessary procedures.