Diagnostic and prognostic significance of p16, p53, and PD-L1 expression in cervical lesions: A combined immunohistochemical, histopathological, and radiological correlation study.

Abstract

Background: Cervical cancer (CC) remains a major cause of cancer-related morbidity and mortality, particularly in low and middle-income countries. Early diagnosis and accurate prognostication are essential for improving patient outcomes.

Objective: To evaluate the immuno-histochemical expression of p16 INK4a, p53, and PD-L1 in cervical lesions and to correlate these markers with histopathological grading and radiological findings.

Materials and methods: This prospective cross-sectional study included 100 cervical biopsy specimens collected over 18 months. Histopathological examination and immunohistochemical analysis for p16 INK4a, p53, and PD-L1 were performed. Radiological assessments, including pelvic ultrasound and MRI, were co-related with histopathological and immunohistochemical findings. Statistical analysis was conducted using the Chi-square test, with a significance level set at P < 0.05.

Results: p16 INK4a expression was significantly elevated in high-grade cervical intraepithelial neoplasia (CIN) and invasive carcinoma ( P < 0.001), supporting its diagnostic role. p53 overexpression showed a significant association with increasing histological severity ( P = 0.003), particularly in HPV-independent lesions. PD-L1 expression was markedly increased in invasive carcinomas and correlated significantly with radiologically detected lymphadenopathy ( P = 0.007). MRI findings were consistent with immunohistochemical profiles in determining tumor aggressiveness and potential immune evasion.

Conclusions: The combined assessment of p16 (INK4a), p53, and PD-L1 enhances diagnostic and prognostic stratification of cervical lesions. Integration of radiological imaging further improves diagnostic accuracy and may assist in treatment planning. This multimodal approach is cost-effective and particularly beneficial in resource-limited settings.