Department of Cellular Pathology, University Hospital of North Durham, Durham, United Kingdom.
Department of Cellular Pathology, New Cross Hospital, Wolverhampton, United Kingdom.
Indian J Pathol Microbiol. 2024 Jan-Mar;67(1):68-73. doi: 10.4103/ijpm.ijpm_748_22.
Typing and grading of endometrial carcinomas (ECs) on small biopsy specimens is crucial to determine the need for full surgical staging. Histological subtype and grade are key factors available for risk stratification before surgery. However, this can be diagnostically challenging on small biopsy specimens, especially when morphologic features are subtle or overlapping.
The aims of this audit were to assess concordance of endometrial carcinomas on biopsy specimens with hysterectomy specimens and to determine if the immunohistochemistry (IHC) panel being used in our practice was adequately subtyping ECs.
The audit was approved by the Clinical Effectiveness Team of the Royal College of Pathologists (UK) as meeting all the criteria and standards set out by the College.
Biopsies from 67 cases of EC were compared for histological subtype and grade of endometrioid carcinoma with resection specimens. A re-audit was carried out on 59 cases after implementation of changes recommended by the initial audit.
Two of 35 (6%) tumours defined as G1 on biopsy were upgraded (to G2) on final pathology, as was one of 7 (14%) G2 tumours (to G3). One of these cases had solid areas just amounting to more than 6% on resection. In the second case, a comment was made that assessment had been difficult as the specimen was suboptimally fixed, but nuclei appeared atypical. Of seven G2 biopsies, one case was upgraded to grade 3 on final pathology based on proportion of solid areas. Our data show lower rates of discordance as compared to previous studies and on re-audit, the concordance between endometrioid and nonendometrioid serous carcinoma improved with the addition of immunohistochemistry (IHC) for Phosphatase and tensin homolog (PTEN) to biopsies.
PTEN IHC can complement other stains and aid in the distinction of grade 3 endometrioid carcinoma from serous carcinoma on endometrial biopsies.
在小活检标本上对子宫内膜癌（EC）进行分型和分级对于确定是否需要进行全面的手术分期至关重要。组织学亚型和分级是手术前进行风险分层的关键因素。然而，在小活检标本上进行诊断可能具有挑战性，尤其是当形态特征细微或重叠时。
本审计旨在评估活检标本与子宫切除标本上的子宫内膜癌的一致性，并确定我们实践中使用的免疫组织化学（IHC）检测是否能够充分对 EC 进行亚型分类。
该审计获得了英国皇家病理学院（RCP）临床效果团队的批准，因为它符合学院规定的所有标准和准则。
对 67 例 EC 活检标本进行了组织学亚型和内膜样癌分级的评估，并与切除标本进行了比较。在实施初始审计建议的更改后，对 59 例病例进行了重新审计。
在 35 例 G1 肿瘤中有 2 例（6%）在最终病理上升级（G2），7 例 G2 肿瘤中有 1 例（14%）升级为 G3。其中一个病例在切除标本中有超过 6%的实性区域。在第二个病例中，由于标本固定不理想，评估困难，但细胞核表现出异型性，因此被认为是 G2。在 7 例 G2 活检中，有 1 例因实性区域比例升高而在最终病理上升级为 3 级。与之前的研究相比，我们的数据显示不一致率较低，并且在重新审计中，添加免疫组织化学（IHC）检测磷酸酶和张力蛋白同源物（PTEN）后，内膜样和非内膜样浆液性癌之间的一致性得到了改善。
PTEN IHC 可以补充其他染色剂，并有助于在子宫内膜活检中区分 3 级内膜样癌和浆液性癌。
