Mini-invasive approach to preneoplastic and neoplastic endometrial lesions. Comparative study among histological, cytological and immunohistochemical diagnosis
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Data di Pubblicazione:
2013
Citazione:
Mini-invasive approach to preneoplastic and neoplastic endometrial lesions. Comparative study among histological, cytological and immunohistochemical diagnosis / E. Betto, S. Ronzoni, S. Rossi, D. Tosi, G. Bulfamante, A.M. Marconi. ((Intervento presentato al 60. convegno Annual Meeting of SGI tenutosi a Orlando nel 2013.
Abstract:
Objective: To compare the accuracy of cytology plus immunoistochemistry vs histology in the preoperative diagnosis of endometrial malignancy.
Methods: We prospectively analyzed 142 women with a proliferative endometrial lesion undergoing operative hysteroscopy (ISC): at the time of ISC, the fluid used for saline contrast sonohysterography (SCSH) was collected for cytological analysis and compared to histology. In 9 women a markers board (Notch-1+ER-α+PR-β) expression was analyzed semiquantitatively in term of presence and intensity, on both glandular and stromal samples.
Results: Table 1 shows the comparison between cytological and histological diagnosis.
ISC histological results
Benign Lesions n=134 Malignant Lesions n=8
Endometrial Polyps n=124 Hypertrophy n=3 Typical hyperplasia n=7 Atypical hyperplasia n=4 Cancer n=4
CTM - 0 0 0 0 0
CTM + 0 0 0 0 3
SCSH cytological results Atypia - 116 3 6 1 0
Atypia + 2 0 0 3 3
Inadequate (5%) 5 (4 cervical cells) (1 scant sample) 0 1 (1 cervical cells) 0 1 (hypocellulated)
Cytological sampling was inadequate in 7 cases (5%). The K value between cytology and histology was 98.4% for benign and 85.7% for malignant lesions. Notch-1 revealed a changing expression pattern: absent in benign lesions, focal and marked in atypical hyperplasia and widespread and marked in cancers. Moreover Notch-1 expression was mild and focal in originally cyto-hystologycal benign lesions which turned into atypical hyperplasia during follow up. In cancer cases, ER-α and PR-β were widespread and markedly expressed either in the glandular or stromal layer.
Conclusions: Cytological analysis could be used as a screening test, at least for women at high surgical risk. Notch-1+ER-α+PR-β expression could be predictive for the risk of endometrial malignancy even at an earlier stadium than hyperplasia and could be used to identify the glandular or stromal origin of cancer thus helping in identifying women at increased risk of malignancy.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
E. Betto, S. Ronzoni, S. Rossi, D. Tosi, G. Bulfamante, A.M. Marconi
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