Immunocytochemical examination of PTEN and Ki-67 for endometrial carcinoma using thin-layer endometrial preparations

Abstract

The current study is designed to evaluate certain immunocytochemical (ICC) biomarkers to gain a better cytodiagnosis. For this purpose, 85 patients from March 2016 to March 2019 who planned to get a hysteroscopy assay were recruited. Cytological sampling was conducted by scratching the uterus cavity using SAP-1, and the samples were processed as liquid-based smears, using SurePath technology. 36 patients diagnosed with EC or atypical endometrial hyperplasia were recruited in this study. 33 cases were diagnosed with EC, and 3 cases were diagnosed with atypical endometrial hyperplasia, allocated with EC or precancerous lesions group. 26 cases were diagnosed with benign lesions group. Among these cases, 9 cases were diagnosed with endometrial simple hyperplasia, 2 cases were diagnosed with complicated hyperplasia, 5 cases were diagnosed with an irregular proliferation of endometrium and 10 cases were diagnosed with endometrial polyps. There were 23 cases in the healthy group. Staining in thin-layer endometrial preparations by ICC and using H-score or counting the percentage of stained cells. The presentation of PTEN in normal endometrium, benign lesions, and EC/precancerous lesions were different (p < 0.01). Taking the cut-off value of 50 (Youden’s index: 0.698) PTEN expression for the diagnosis of EC/precancerous lesion, the sensitivity and specificity were 83.7% and 86.1%. The presentation of Ki-67 in normal endometrium, benign lesions, and EC/precancerous lesions were different (p < 0.01). Taking the cut-off value of 15% (Youden’s index: 0.76) Ki-67 expression for the diagnosis of EC/precancerous lesion, the sensitivity and specificity were 94.4% and 81.6%. In this study, the use of different cut-off values for Ki-67 and PTEN helped differentiate endometrial lesions. Immunocytochemistry in the ECT detection of PTEN and Ki-67 can improve the diagnostic capabilities of endometrial cancer and precancerous lesions.