Expression of PTEN in Endometrial Liquid-Based Cytology

Abstract

Objectives: Endometrial cytology offers a reliable alternative to biopsy in endometrial cancer detection and it may be useful in obtaining material to study prognostic and predictive markers. Over the years, new sampling devices have been developed. Molecular alterations in endometrial cancers were previously described using formalin-fixed paraffin-embedded tissues with particular attention, in endometrioid carcinomas, to the PTEN-PI3K pathway. PTEN evaluation could be useful in endometrial carcinomas for selecting patients for target therapies. Study Design: We studied 51 endometrial samples collected using the Endogyn device and 71 obtained with the Endoflower dispositive device, and processed using liquid-based cytology. Most of the cases were matched with a corresponding histological biopsy. The overall accuracy of Endoflower was 100%. Immunohistochemistry (IHC) and immunocytochemistry (ICC) for PTEN were performed using monoclonal antibody 6H2.1 from DAKO. Results: The IHC showed PTEN-null glands in 4 cases. The same cancers were negative in ICC. Among the 10 carcinomas on cytology, PTEN-null glands were found in 1 case. All the normal endometrium control cases were positive in cytology and histology. Conclusions: Our results suggest that endometrial devices provide useful material for the diagnosis and evaluation of PTEN expression.

Diagnostic accuracy of cytology for the detection of endometrial cancer in urine and vaginal samples

“…Premenopausal women made up just 8.3% of our study population in whom it may be challenging to distinguish malignant cells from benign mimics like polyps and cellular changes secondary to intrauterine devices. Adjunctive immunocytochemistry may help to define the malignant character and/or endometrial origin of cells 37,38 and work in this space is ongoing.…”

A Diagnostic Approach to Endometrial Cytology by Means of Liquid-Based Preparations

“…Because the overexpression of gene products of types I and II ECs correlates with clinicopathological factors and prognosis, it is also important to evaluate the immunocytochemical (ICC) expression of endometrial malignancy markers including precursor lesions on LBC samples. For PTEN staining, the expression should be reduced to ≥50% [52,53] to be helpful for a diagnosis of EC; data on usefulness of PTEN staining were also confirmed by Di Lorito et al [54]. Both nuclear and cytoplasmic β-catenin should be underexpressed in type II EC.…”

The Yokohama system for reporting directly sampled endometrial cytology: The quest to develop a standardized terminology

“…In particular the accurate identification of these abnormalities could be an important part of the patient triage and it will also be necessary for the selection of patients who could benefit from targeted‐therapies in advanced or metastatic endometrial cancer women. In this setting, endometrial LBC is an accessible, simple and reproducible tool and it can be used to apply ancillary techniques …”

“…[26][27][28][29] Mutations of PTEN gene can be detected using molecular techniques applied also on LBC samples. 30 The loss of PTEN protein can be evaluated by ICC with the application of standard techniques with concordant IHC results.…”

“…In this setting, endometrial LBC is an accessible, simple and reproducible tool and it can be used to apply ancillary techniques. 29,30…”