Clinic of Obstetrics and Gynecology, 'Santa Maria della Misericordia' University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, Sassari, Italy.
Int J Gynecol Cancer. 2024 Aug 5;34(8):1211-1216. doi: 10.1136/ijgc-2024-005478.
Molecular features are essential for estimating the risk of recurrence and impacting overall survival in patients with endometrial cancer. Additionally, the surgical procedure itself could be personalized based on the molecular characteristics of the tumor. This study aims to assess the feasibility of obtaining reliable molecular classification status from biopsy specimens collected during hysteroscopy to better modulate the appropriate surgical treatment.
This monocentric, retrospective, observational study was conducted on 106 patients who underwent a biopsy procedure followed by radical surgery for endometrial cancer, with concurrent molecular investigation. The molecular classification was determined through immunohistochemical staining for p53 and mismatch repair proteins, along with gene sequencing for POLE.
Overall, 106 patients underwent molecular investigation, which was finally achieved on 99 patients (93.4%). Among these, the molecular analysis was conducted in 71 patients (67%) on the pre-operative endometrial biopsy and on the final uterine specimen in 28 patients (26.4%). Most of the endometrial biopsies were performed using Bettocchi hysteroscopy (66%). Molecular analysis was not possible in seven patients (6.6%), with six cases due to sample inadequacy and one case attributed to intra-mucosal carcinoma. The molecular results showed that the copy number low sub-group was the most common, and five cases of 'multiple classifiers' were observed in the low-risk category.
Our experience in obtaining molecular information from biopsy samples underscores the feasibility and efficacy of this technique, even in small tissue samples. This capability helps define the prognostic group of patients, facilitates timely decision-making, and develops a personalized strategy for each patient.
分子特征对于评估子宫内膜癌患者的复发风险和影响总生存率至关重要。此外，手术本身可以根据肿瘤的分子特征进行个性化。本研究旨在评估从宫腔镜活检标本中获取可靠分子分类状态的可行性，以更好地调节适当的手术治疗。
这是一项单中心、回顾性、观察性研究，纳入了 106 名接受活检后行根治性手术治疗子宫内膜癌的患者，并进行了同步的分子研究。通过 p53 和错配修复蛋白的免疫组织化学染色以及 POLE 的基因测序来确定分子分类。
总共对 106 名患者进行了分子研究，最终有 99 名患者（93.4%）完成了分子分析。其中，71 名患者（67%）在术前子宫内膜活检和 28 名患者（26.4%）的最终子宫标本上进行了分子分析。大多数子宫内膜活检是使用 Bettocchi 宫腔镜进行的（66%）。有 7 名患者（6.6%）无法进行分子分析，其中 6 例是由于样本不足，1 例是由于粘膜内癌。分子结果显示，拷贝数低亚组最为常见，在低危组中观察到 5 例“多分类器”。
我们从活检样本中获取分子信息的经验强调了这种技术的可行性和有效性，即使在小组织样本中也是如此。这种能力有助于确定患者的预后组，促进及时决策，并为每位患者制定个性化策略。
