Predicting the Coexistence of an Endometrial Adenocarcinoma in the Presence of Atypical Complex Hyperplasia: Immunohistochemical Analysis of Endometrial Samples

Robbe, Elisabeth J.; Kuijk, Sander M. J. van; Boed, Ella M. de; Smits, Luc; Wurff, A.A.M. van der; Kruitwagen, Roy F.P.M.; Pijnenborg, Johanna M.A.

doi:10.1097/igc.0b013e31826302a3

Cited by 21 publications

(19 citation statements)

References 49 publications

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“…60% of females with CAH had concurrent endometrial carcinoma, which is similar to recent reports (Robbe et al, 2012). Therefore, each patient should be evaluated individually and be informed of the risks of medical therapy.…”

Section: Discussionsupporting

confidence: 83%

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Mesci-Haftaci

Ankaralı²,

Yavuzcan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia. Materials and Methods: A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test. Results: Among the 415 females (average age, 53.5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy. Conclusions: The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

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Section: Discussionsupporting

confidence: 83%

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Mesci-Haftaci

Ankaralı²,

Yavuzcan³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…Twenty‐seven observational studies were included in the systematic review: 19 adopted the WHO classification and eight adopted the EIN classification. A total of 1736 cases of EH were included; 847 (48.8%) EH were classified as “precancer” and 889 (51.2%) as “benign.” PTEN loss was observed in 443 of 847 (52.3%) premalignant EH and 299 of 889 (33.6%) benign EH.…”

Section: Resultsmentioning

confidence: 99%

Loss of PTEN expression as diagnostic marker of endometrial precancer: A systematic review and meta‐analysis

Raffone

Travaglino

Saccone

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: AUC, area under the curve; D, D-score; DOR, diagnostic odds ratio; EH, endometrial hyperplasia; EIN, endometrial intraepithelial neoplasia; LR+, positive likelihood ratio; LR−, negative likelihood ratio; PTEN, tumor suppressor protein phosphatase and tensin homolog; SROC, summary receiver operating characteristic; WHO, World Health Organization. AbstractIntroduction: Endometrial hyperplasia may be either a benign proliferation or a premalignant lesion. In order to differentiate these two conditions, two possible histologic classifications can be used: the World Health Organization (WHO) classification and the endometrial intraepithelial neoplasia (EIN) classification. The 2017 European Society of Gynaecological Oncology guidelines recommend the use of immunohistochemistry for tumor suppressor protein phosphatase and tensin homolog (PTEN) to improve the differential diagnosis. Nonetheless, its diagnostic accuracy has never been defined. We aimed to assess the diagnostic accuracy of immunohistochemistry for PTEN in the differential diagnosis between benign and premalignant endometrial hyperplasia. Material and methods: Electronic databases were searched from their inception toMay 2018 for studies assessing immunohistochemical expression of PTEN in endometrial hyperplasia specimens. PTEN status ("loss" or "presence") was the index test; histological diagnosis ("precancer" or "benign") was the reference standard.Sensitivity, specificity, positive and negative likelihood ratios (LR+, LR−), diagnostic odds ratio (DOR), and area under the curve (AUC) on summary receiver operating characteristic curves were calculated (95% CI), with a subgroup analysis based on the histologic classification adopted (WHO vs EIN).Results: Twenty-seven observational studies with 1736 cases of endometrial hyperplasia were included. Pooled estimates showed low diagnostic accuracy: sensitivity 54% (95% CI 50%-59%), specificity 66% (63%-69%), LR+ 1.55 (1.29-1.87), LR− 0.72 (0.62-0.83), DOR 3.56 (2.02-6.28), AUC 0.657. When the WHO subgroup was compared with the EIN subgroup, higher accuracy (AUC 0.694 vs 0.621), and higher heterogeneity in all analyses, were observed. Conclusions:Immunohistochemistry for PTEN showed low diagnostic usefulness in the differential diagnosis between benign and premalignant endometrial hyperplasia.In the absence of further evidence, the recommendation about its use should be reconsidered.

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“…A small retrospective study showed that loss of PTEN expression can be used to predict a coexisting endometrial carcinoma in complex atypical hyperplasia. This prediction model can be enhanced by also incorporating MIB-1 and p53 expression levels (discriminative power 87.2%, 95% CI 75.1-99.3%) [16].…”

Section: Ptenmentioning

confidence: 99%

The role of biomarkers in endometrial cancer and hyperplasia: a literature review

et al. 2019

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Introduction: Endometrial cancer is the most common gynaecological cancer and its incidence is rising due to increasing obesity rates. We are also seeing an increasing trend of young women diagnosed with either endometrial cancer or its precancerous state, endometrial hyperplasia. Diagnosis is dependent on invasive testing and there is no screening tool available for either general or high-risk population groups.Whilst vast amounts of research have been undertaken in higher-profile cancers such as ovarian and cervical, endometrial cancer is comparatively less investigated. Aim: In this literature review, we summarise the existing literature in understanding the role of tumour biomarkers for endometrial cancer and its preceding condition of endometrial hyperplasia. Method: NICE Healthcare Databases Search tool was used to search Embase, Medline and PubMed databases for relevant articles. Conclusion: There is currently no routinely used biomarker in endometrial cancer for diagnostic or prognostic purposes. Given the establishment of new genomic classifications of endometrial cancers, the use of biomarkers to drive therapeutic approaches will be the cornerstone for individualised cancer care in the coming decades. ARTICLE HISTORY

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Predicting the Coexistence of an Endometrial Adenocarcinoma in the Presence of Atypical Complex Hyperplasia: Immunohistochemical Analysis of Endometrial Samples

Abstract: This study showed that PTEN expression in complex endometrial hyperplasia is a promising factor for the prediction of the presence of a coexisting endometrial carcinoma, and prediction may even better when MIB-1 and p53 expressions are considered simultaneously.

Cited by 21 publications

References 49 publications

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Endometrial Curettage in Abnormal Uterine Bleeding and Efficacy of Progestins for Control in Cases of Hyperplasia

Loss of PTEN expression as diagnostic marker of endometrial precancer: A systematic review and meta‐analysis

The role of biomarkers in endometrial cancer and hyperplasia: a literature review

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