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What is the value of proliferation markers in the normal and neoplastic
cervix?
M.K. Heatley
Department of Cellular Pathology, Taunton and Somerset
NHS Trust, Musgrove Park Hospital, Taunton, Somerset, United Kingdom
Offprint requests to: Dr. M.K.
Heatley, Department of Cellular Pathology, Taunton and Somerset NHS Trust,
Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, United Kingdom
Summary. Markers of cellular
proliferation have been widely applied in cervical disease and include tech-niques
which are applicable to routinely processed tissue including standard hematoxylin
and eosin sections, and sections labelled with antibodies to Ki-67 and PCNA
proteins. Flow cytometry and in vivo techniques including labelling with
Bromodeoxyuridine (BrdU) and radiolabelled thymidine require more specialized
facilities. Increases in the mitotic index and the Ki-67 and PCNA labelling
indices, the incidence of aneuploidy together with increases in in vivo
labelling with BrdU and radiolabelled thymidine have been demonstrated as
the grade of cervical intraepithelial neoplasia (CIN) increases. With respect
to invasive tumours increases in these parameters are associated with increased
tumour size, stage and improved survival after radio-therapy.
At present the major practical application of these markers
appears to be in distinguishing between post-menopausal atrophy and CIN
lesions on histological sections and, in combination with the Papnet system,
in identifying high grade dyskaryosis on blood stained cervical smears.
Future development may permit the identification of those patients whose
CIN lesion will progress, and who require treatment, to be distinguished
from those whose lesions will stay static or regress and who can be followed
up cytologically. This promises a more rational use of health care resources.
Most of the studies to date have been on small numbers
of cases. Meta-analysis of existing studies and large, possibly multicentric,
prospective studies are needed to elucidate the value of these markers.
Histol Histopathol 13, 249-254 (1998)
Key words: Cervix, Cervix neoplasms,
Cervical intra-epithelial neoplasia, Cell division, Flow cytometry, Nuclear
proteins, Nucleolus organizer region
DOI: 10.14670/HH-13.249
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