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PAX2 in endometrial carcinogenesis and in differential diagnosis of endometrial hyperplasia: A systematic review and meta-analysis of diagnostic accuracy
| Content Provider | Scilit |
|---|---|
| Author | Raffone, Antonio Travaglino, Antonio Saccone, Gabriele Mascolo, Massimo Insabato, Luigi Mollo, Antonio Placido, Giuseppe De Zullo, Fulvio |
| Copyright Year | 2018 |
| Description | Journal: Acta Obstetricia et Gynecologica Scandinavica Introduction Benign and precancerous endometrial hyperplasias (EH) are differentiated according to two alternative histomorphologic classifications: World Health Organization (WHO) or Endometrial Intraepithelial Neoplasia (EIN) system. 2018 European Society of Gynaecological Oncology (ESGO) guidelines recommends paired box 2 protein (PAX2) immunohistochemistry to identify precancerous EH. However, methods for interpreting immunostaining and diagnostic accuracy are not defined, and the role of PAX2 in endometrial carcinogenesis is unclear. We aimed to assess: 1) PAX2 expression throughout endometrial carcinogenesis, from normal endometrium to benign EH, precancerous EH and endometrial cancer; 2) the diagnostic accuracy of PAX2 immunohistochemistry in diagnosing precancerous EH, defining criteria for its use. Material and methods Electronic databases were searched for from their inception to July 2018. All studies evaluating PAX2 immunohistochemistry in normal endometrium, EH and endometrial cancer were included. Univariate comparisons of PAX2 expression were performed with Fisher's exact test (significant p‐value<0.05). Sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio and area under the curve on summary receiver operating characteristic curves were calculated. Subgroup analyses were based on expression thresholds (decrease vs complete loss) and classifications used (WHO vs EIN). Results Six studies with 266 normal endometrium, 586 EH and 114 endometrial cancer were included. Both decrease and complete loss of PAX2 expression were significantly more common in endometrial cancer and precancerous EH than benign EH. Diagnostic accuracy was moderate for both PAX2 complete loss and decrease (area under the curve =0.829 and 0.876, respectively). PAX2 complete loss with EIN system showed the best results (sensitivity=0.72; specificity=0.95; diagnostic odds ratio =43.13). Conclusions PAX2 seems to behave as tumor suppressor in endometrial carcinogenesis. PAX2 is an accurate marker of precancerous EH; complete loss of PAX2 and EIN classification appear as the optimal diagnostic criteria. |
| Ending Page | 299 |
| Starting Page | 287 |
| ISSN | 00221295 |
| e-ISSN | 16000412 |
| DOI | 10.1111/aogs.13512 |
| Journal | Acta Obstetricia et Gynecologica Scandinavica |
| Issue Number | 3 |
| Volume Number | 98 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2019-03-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Acta Obstetricia et Gynecologica Scandinavica Reproductive Biology Endometrial Hyperplasia Endometrial Intraepithelial Neoplasia Cancer Precursor Endometrioid Adenocarcinoma |
| Content Type | Text |
| Resource Type | Article |
| Subject | Obstetrics and Gynecology |
