5 курс / Онкология / Клинико_морфологические_особенности_злокачественной

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Table 6 continued

Comparative characteristics of groups by IHC parameters

The comparison of the studied groups on the expression of IHC markers was carried out. The results are presented in Table 6.

If there are significant differences between the groups (p<0.05) according to the test results (ChiSq or Fisher), the odds ratio (OR), relative risk (RR) sensitivity and specificity were calculated (Table 7).

Table 7 – Diagnostic accuracy of IHC markers for differentiation of benign, precancerous and oncological diseases of the endometrium) [121]

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Table 7 continued

Note – RR – relative risk; EH – endometrial hyperplasia without atypia; EIN – endometrioid intraepithelial neoplasia; EC – endometrioid adenocarcinoma of the endometrium.

Expression of the ARID1a gene

There were no significant differences between the groups of EH without atypia and EIN. Loss of expression of the ARID1a gene was not observed either in cases of EH without atypia (Figure 13) or in cases of EIN (Figure 14).

Figure 13 – ARID1a positive staining in the preparation of endometrial hyperplasia without atypia, 200

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Figure 14 – ARID1a positive staining in the preparation of endometrioid intraepithelial neoplasia, 200

Significant differences were revealed between the groups of EIN and EC, EH without atypia and EC on the basis of loss of expression of ARID1a (assessed as the absence of staining in the IHC analysis).

Loss of ARID1a expression is most characteristic of EС, occurring in 67% of all studied cases of EС (Figure 15).

Figure 15 – ARID1a staining in tumor cells in the preparation endometriodic endometrial adenocarcinoma 200

According to the obtained data, when ARID1a falls out, EС is diagnosed 2.3 times more often than EIN and EH. In the differential diagnosis of EC from EIN

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PTEN negative staining in the preparation of endometrial adenocarcinoma with foci of EIN, ×200;

Figure 17 – Expression of the PTEN gene

in preparations of endometrioid intraepithelial neoplasia and endometrioid endometrial cancer

In the differential diagnosis of EIN and EC from EH, the sensitivity of this marker is 67%, and the specificity is 97% (Table 7) [171].

Assessment of microsatellite instability status

(expression of 4 genes: MSH6 and MSH2, PMS2 and MLH1)

There were no significant differences in the paired MSH6 and MSH2 genes in the groups. The absence of staining was observed only in one case of EC.

For the PMS2 and MLH1 genes, significant differences were found in the EIN and EC, EH and EC groups. There were no differences in the EH and EIN groups.

The relative risk of detecting EC in the presence of PMS2 and MLH1 loss is 2.3 times higher than the detection of EH and EIN.

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Figure 20 – MLH 1 positive staining

in the preparation of benign endometrial hyperplasia (without dMMR), ×200

The sensitivity of the MSI determination method in the differential diagnosis of EC from EH and EIN was 36%, and the specificity was 100% and 97%, respectively (Table 7).

Expression of the PAX2 gene

Most often, the loss of PAX2 expression (absence of staining during the IHC reaction) is observed in the EIN groups (in 89% of cases) (Figure 21) and EC (in 86% of cases) (Figure 22), practically does not occur in the EH group (detected only in 2 patients – 6%) (Figure 23).

Figure 21 – Immunohistochemical study of Pax2 in endometrioid intraepithelial neoplasia preparations

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Expression of Ki-67

The Ki-67 proliferation index significantly differed in the three study groups, with the lowest value in the EH group and the highest in the EC group (p=0.004) (Table 7, Figure 24).

Ki-67 – 5% (few colored nuclei), 200; Ki-67 – 20%, 200;

Endometrioid adenocarcinoma of the endometrium

Ki 67 – 65% (many colored nuclei), 200.

Figure 24 – Examples of IHC staining Ki-67

A pairwise comparison of the data revealed differences in the Ki 67 index in the EH groups without atypia and EC and the EIN and EC groups, with a higher proliferation index value in the EC group than in the EH group without atypia and EIN.

A tendency to increase the Ki 67 index with an increase in the degree of cellular atypia was revealed: the lowest values were in women with EH and

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