Characterising Endometrial Hyperplasias: The role of immunohistochemistry and pathological classification to gauge neoplastic potential.

Peter Sanderson, Arantza Esnal-Zufiurre, Hilary Critchley, Philippa Saunders, Mark Arends, Alistair Williams

Research output: Contribution to conferencePosterpeer-review

Abstract / Description of output

Introduction:
Endometrial hyperplasias (EHs) represent a spectrum of morphological endometrial alterations. Atypical EHs are considered premalignant lesions for endometrioid endometrial cancer. Two classification systems exist for EHs: 1) The World Health Organisation (WHO) 1994 system; widely used in UK gynaecological practice, dividing EHs into 4 groups based on architectural and cytological features and 2) The Endometrial Intraepithelial Neoplasia (EIN) 2000 system; adopted by the WHO in 2014, dividing EHs into 2 groups, with emphasis on diagnostic reproducibility and recognition that EIN lesions are monoclonal premalignancies. Our aim is to investigate neoplastic vs. endocrine-driven variations within EHs, via characterisation of key molecular features in the context of these classification systems.
Methods:
Pathology records coded as EH within NHS Lothian were reviewed (n=143) from 2004-2009. After exclusions, diagnostic samples (n=127) were evaluated by an expert gynaecological pathologist (blinded to diagnosis) to: 1) Confirm WHO94 diagnosis and 2) Reclassify under EIN criteria. Corresponding FFPE sections were obtained and immunohistochemistry (IHC) performed for markers predicted to be informative, including: PTEN, Ki67 and HAND2.
Results:
Original WHO94 diagnoses and expert pathologist WHO94 review diagnoses were concordant in 52% of cases (n=66). 7% (n=9) originally diagnosed as simple non-atypical hyperplasia and 12% (n=15) originally diagnosed as complex non-atypical hyperplasia were reclassified as EIN. IHC was evaluated to support EIN classification.
Conclusion:
Interobserver variation when diagnosing EHs using WHO94 classification is apparent. Disparity between EH classification systems may create potential for under/overtreatment. IHC panels can provide a valuable adjunct to pathological diagnosis when assessing EH neoplastic potential.
Original languageEnglish
Publication statusPublished - 3 Mar 2016
EventRCOG Annual Academic Meeting - Royal College of Obstetricians & Gynaecologists, London, United Kingdom
Duration: 3 Mar 20164 Mar 2016

Conference

ConferenceRCOG Annual Academic Meeting
Country/TerritoryUnited Kingdom
CityLondon
Period3/03/164/03/16

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