TY - JOUR
T1 - Predicting the Coexistence of an Endometrial Adenocarcinoma in the Presence of Atypical Complex Hyperplasia Immunohistochemical Analysis of Endometrial Samples
AU - Robbe, Elisabeth J. M.
AU - van Kuijk, Sander M. J.
AU - de Boed, Ella M.
AU - Smits, Luc J. M.
AU - van der Wurff, Anneke A. M.
AU - Kruitwagen, Roy F. P. M.
AU - Pijnenborg, Johanna M. A.
PY - 2012/9
Y1 - 2012/9
N2 - Objective: This study aimed to determine whether immunohistochemical markers in complex atypical endometrial hyperplasia could predict the presence of a concurrent endometrial carcinoma. Methods: Endometrial biopsies of 39 patients with complex atypical hyperplasia were selected retrospectively between 1999 and 2006. Only patients who underwent a hysterectomy were included. A coexisting endometrial carcinoma was present in 25 patients (64%). Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded sections of the endometrial biopsies, using antibodies for MIB-1, beta-catenin, E-cadherin, p53, PTEN, CD44, HER2-neu, survivin, COX-2, tenascin, and bcl-2. To evaluate the potential utility of these markers, a prediction model was constructed. Results: In the univariate analysis, expressions of both PTEN and HER2-neu were significantly different between the groups with and without a coexisting endometrial carcinoma (P <0.05). Loss of PTEN staining was found in 13 (54%) and 1 (7%) of the patients with and without a coexistent carcinoma, respectively (odds ratio, 16.55; 95% confidence interval [CI], 1.87-146.65). HER2-neu expression was found in only 2 (8.6%) and 6 (43%) patients with and without a coexistent carcinoma, respectively, and was excluded from further analysis because of its low expression. A prediction model containing PTEN expression only showed an area under the curve of 73.4% (95% CI, 57.3%-89.6%). After adding MIB-1 and p53, discriminative power improved to 87.2% (95% CI, 75.1%-99.3%). Conclusions: 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.
AB - Objective: This study aimed to determine whether immunohistochemical markers in complex atypical endometrial hyperplasia could predict the presence of a concurrent endometrial carcinoma. Methods: Endometrial biopsies of 39 patients with complex atypical hyperplasia were selected retrospectively between 1999 and 2006. Only patients who underwent a hysterectomy were included. A coexisting endometrial carcinoma was present in 25 patients (64%). Immunohistochemical analysis was performed on formalin-fixed paraffin-embedded sections of the endometrial biopsies, using antibodies for MIB-1, beta-catenin, E-cadherin, p53, PTEN, CD44, HER2-neu, survivin, COX-2, tenascin, and bcl-2. To evaluate the potential utility of these markers, a prediction model was constructed. Results: In the univariate analysis, expressions of both PTEN and HER2-neu were significantly different between the groups with and without a coexisting endometrial carcinoma (P <0.05). Loss of PTEN staining was found in 13 (54%) and 1 (7%) of the patients with and without a coexistent carcinoma, respectively (odds ratio, 16.55; 95% confidence interval [CI], 1.87-146.65). HER2-neu expression was found in only 2 (8.6%) and 6 (43%) patients with and without a coexistent carcinoma, respectively, and was excluded from further analysis because of its low expression. A prediction model containing PTEN expression only showed an area under the curve of 73.4% (95% CI, 57.3%-89.6%). After adding MIB-1 and p53, discriminative power improved to 87.2% (95% CI, 75.1%-99.3%). Conclusions: 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.
KW - Atypical endometrial hyperplasia
KW - Endometrial carcinoma
KW - PTEN
KW - Coexistent carcinoma
KW - Prediction
KW - Immunohistochemistry
U2 - 10.1097/IGC.0b013e31826302a3
DO - 10.1097/IGC.0b013e31826302a3
M3 - Article
C2 - 22872167
SN - 1048-891X
VL - 22
SP - 1264
EP - 1272
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 7
ER -