Lesions sub-diagnostic of endometrioid intra-epithelial neoplasia/atypical hyperplasia: value of morphology and immunohistochemistry in predicting neoplastic outcome

IF 3.9 2区医学 Q2 CELL BIOLOGY

Histopathology Pub Date : 2024-05-24 DOI:10.1111/his.15215

Nicolas Wyvekens, George L Mutter, Marisa R Nucci, David L Kolin, Carlos Parra-Herran

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Abstract

Aims

Areas of gland crowding that do not fulfil diagnostic criteria of endometrioid intra-epithelial neoplasia (EIN) are often encountered in endometrial biopsies. In this study, we document the prevalence of neoplastic outcome in patients with these subdiagnostic lesions (SL) and assess the utility of morphological features and a three-marker immunohistochemistry panel (PAX2, PTEN, beta-catenin) to predict outcome.

Methods and results

Of 430 women with SL on endometrial sampling at Brigham and Women's Hospital between 2001 and 2021 with available follow-up biopsy, 72 (17%) had a neoplastic outcome (EIN or endometrioid carcinoma). Multilayered epithelium and mitoses in SL were statistically associated with a neoplastic outcome. Abnormal three-marker staining was observed in 93% (53 of 57) of SL with neoplastic outcome and 60% (37 of 62) of a control group with benign outcome. Among the 72 patients with neoplastic outcome, EIN/carcinoma tissue was available in 33; of these, 30 (91%) showed abnormal staining for one or more markers. Remarkably, in 84% of these cases the EIN/carcinoma had the aberrant expression seen in the preceding SL. Based on a prevalence of 17%, the positive and negative predictive values of abnormal staining in one or more markers were 24 and 97%, respectively.

Conclusions

The presence of SL warrants clinical surveillance and repeat sampling because it is followed by endometrioid neoplasia in a significant subset of patients. Normal three-marker staining identifies women with a very low risk of neoplastic outcome. Conversely, abnormal staining is frequent in SL with benign outcome leading to poor specificity and positive predictive value.

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子宫内膜样上皮内瘤变/典型增生的亚诊断病变：形态学和免疫组化在预测肿瘤结果中的价值。

目的：在子宫内膜活检中经常会遇到不符合子宫内膜样上皮内瘤变（EIN）诊断标准的腺体拥挤区。在这项研究中，我们记录了这些亚诊断病变（SL）患者肿瘤性结局的发生率，并评估了形态学特征和三标记免疫组化面板（PAX2、PTEN、β-catenin）在预测结局方面的效用：2001年至2021年期间，布里格姆妇女医院对430名子宫内膜取样并进行随访活检的SL女性中，72人（17%）的结果为肿瘤性（EIN或子宫内膜样癌）。SL中的多层上皮和有丝分裂与肿瘤结果有统计学关联。在93%（57例中的53例）肿瘤性SL和60%（62例中的37例）良性SL对照组中，均观察到异常的三标记染色。在72例肿瘤性患者中，有33例获得了EIN/癌组织，其中30例（91%）的一种或多种标记物染色异常。值得注意的是，在这些病例中，84%的EIN/癌具有前一种SL的异常表达。根据17%的发病率计算，一种或多种标记物染色异常的阳性预测值为24%，阴性预测值为97%：结论：子宫内膜异位症的出现需要临床监测和重复采样，因为在相当一部分患者中，子宫内膜异位症之后会出现子宫内膜样肿瘤。三标记染色正常的妇女发生肿瘤的风险很低。相反，在良性结果的 SL 中经常出现染色异常，导致特异性和阳性预测值较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Histopathology 医学-病理学

CiteScore

10.20

自引率

4.70%

发文量

239

审稿时长

1 months

期刊介绍： Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.