Interobserver agreement in the diagnosis of endometrial atypical hyperplasia and the contribution of PTEN immunohistochemistry

Interobserver agreement in the diagnosis of endometrial atypical hyperplasia and the contribution of PTEN immunohistochemistry. Download PDF Abstract Endometrial atypical hyperplasia (EAH) is a precancerous lesion whose distinction from non-atypical hyperplasia and endometrioid carcinoma carries major therapeutic implications, particularly in young women eligible for fertility-sparing treatment. Because diagnostic reproducibility remains limited, we assessed interobserver concordance for EAH and explored the contribution of PTEN immunohistochemistry, used here as a single, readily available ancillary marker.

In this retrospective, multicenter study, 121 patients of reproductive age with an outside diagnosis of EAH, referred within the PREFERE registry (2017–2023), underwent independent histological re-evaluation by two expert gynecological pathologists according to the WHO 2020 classification; cytonuclear atypia criteria were further analyzed in the 55 cases with slides available for a second review, including 46 with PTEN immunohistochemistry. The concordance rate was 97.5% for the diagnosis of hyperplasia but only 71% for EAH specifically; in 29% of cases the diagnosis was revised after review, most often to non-atypical hyperplasia (62.8%) or adenocarcinoma (17%). Complex architecture was present in 94% of EAH versus 50% of non-atypical hyperplasias, and the diagnosis of EAH relied on the combination of several cytonuclear criteria rather than any single feature.

PTEN loss was more frequent in EAH than in non-atypical hyperplasia (75% vs. Interobserver agreement for EAH remains only moderate, reinforcing the value of expert re-review for the fertility-sparing management of these young patients; confirmation in larger, multi-observer series using the complete recommended biomarker panel (PTEN, PAX2, β-catenin) is warranted. Explore related subjects Discover the latest articles and news in related subjects.

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