Insulin‐like growth factor‐II mRNA‐binding protein 3 immunocytochemical expression in direct endometrial brushings: Possible diagnostic help in endometrial cytology

Abstract

IntroductionThis study evaluated the immunocytochemical (ICC) expression of IMP3 in direct endometrial brushings processed as liquid‐based cytology (LBC) samples of endometrioid adenocarcinoma (EAC), serous carcinoma (ESC) and surface papillary syncytial change (SPSC) with endometrial glandular and stromal breakdown (EGBD) to exploit its possible differential diagnostic aid.MethodsIn total, 333 samples of LBC samples were obtained from selected outpatients in parallel with Pipelle endometrial sampling. They consisted of 97 EAC (83 grade 1: EAC‐1, 14 EAC‐3), 35 ESC and 201 benign endometrial samples (51 proliferative, 42 secretory, 38 atrophic, 70 SPSC with EGBD). ICC expression of insulin‐like growth factor‐II mRNA‐binding protein 3 (IMP3) was manually performed on Papanicolaou‐stained LBC samples.ResultsThe ESC samples showed positive staining cells in 100%, EAC‐3 in 28.5%, and EAC‐1 in 2.4% cases. All the benign endometrium samples were negative. Only ESC cases showed strong immunoreactivity (≥3+) in more than 50% of tumour cells with an average frequency of 80%.ConclusionsIMP3 is a helpful immunomarker to distinguish ESC from EAC and SPSC in endometrial cytology.

Nuclear morphometry as an adjunct to cytopathologic examination of endometrial brushings on LBC samples: A prospective approach to combined evaluation in endometrial neoplasms and look alikes

“…Unfortunately, cytological diagnosis of endometrial brushings is frequently hampered by the presence of benign endometrial lesions (eg reactive or metaplastic changes), masking or mimicking a malignancy. In particular, SPSC is frequently observed in association with EGBD, a relatively common clinical manifestation necessitating endometrial cytological examination in several patients; furthermore, it may be detected in abnormal endometrial conditions such as polyps and hyperplasias, and even in biopsies of EC obtained during metrorrhagia 11‐13,20 …”

“…In particular, SPSC is frequently observed in association with EGBD, a relatively common clinical manifestation necessitating endometrial cytological examination in several patients; furthermore, it may be detected in abnormal endometrial conditions such as polyps and hyperplasias, and even in biopsies of EC obtained during metrorrhagia. [11][12][13]20 Additionally, as SPSC may occasionally display papillary architecture and a degree of nuclear atypia resembling ESC (including its precursor lesion), it may be misdiagnosed as a malignancy (Figures 2 and 3). 21,22 Hence, the cytological distinction between a benign endometrium and a malignant one is of critical significance given the subsequent triage (e.g.…”

“…Using endometrial cytology, Pouliakis et al 10 have attempted to reduce the subjectivity introduced by humans, providing a more objective methodology with the classification and regression trees (CARTs) system. Therefore, the introduction of an objective methodology for the assessment of nuclear features is considered necessary to distinguish between benign and malignant disease [11][12][13] or between LG-EC and HG-EC. [3][4][5][6] In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings determined by image morphometry in LBC endometrial cytology are useful when compared with microscopic evaluation.…”

“…Therefore, the introduction of an objective methodology for the assessment of nuclear features is considered necessary to distinguish between benign and malignant disease 11‐13 or between LG‐EC and HG‐EC 3‐6 . In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings determined by image morphometry in LBC endometrial cytology are useful when compared with microscopic evaluation.…”

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

“…Several authors [65][66][67][68] reported that "insulinlike growth factor-II mRNA-binding protein 3 (IMP3)" is a useful ICC marker to distinguish between ESC and EAC (G1, G3). Very recently, Norimatsu et al [69] also found that IMP3 is one of the helpful ICC markers to distinguish ESC from EAC (G1, G3) or MCIP. When the score ≥3 threshold for positivity of IMP3 ICC expression was used, only ESC cases showed significantly higher expression than EAC (G1, G3) cases, while all of the benign endometrium cases including MCIP showed negative cytoplasmic staining.…”