Endometrial cancer management guidelines updated: assorting the uncertainties! -----3

The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11–13 December 2014 in Milan, Italy.

These guidelines were published in an article by Colombo N et al in January issue of Annals of Oncology. 

These guidelines were developed based on 12 questions identified by the expert panel.

The earlier 2 questions were answered in previous parts.

The third question is: Which (molecular) Markers Can Help Distinguish (pre)Cancerous Lesions from Benign Mimics?

 

Differential diagnosis between benign uterine lesions and endometrial (pre)carcinomas is based mainly on morphological criteria but may be supported by additional immunohistochemical (IHC) markers and molecular alterations in problematic cases.

Currently, AH/EIN is the preferred terminology of the precursor lesion of the most common type of endometrial carcinoma, endometrioid carcinoma, including its variants.

Recommendation 3.1: In case of uncertainty low threshold referral to a specialised gynaecopathologist is recommended.Level of evidence: V,Strength of recommendation:A.


Recommendation 3.2: PTEN and PAX-2 IHC is recommended to distinguish AH/EIN from benign mimics. Other markers that can be used in this context are MLH1 and ARID1a by IHC.Level of evidence: IV,Strength of recommendation: B


Recommendation 3.3: IHC is not recommended to distinguish APA from AH/EIN.Level of evidence: V,Strength of recommendation: B


Recommendation 3.4: p53 by IHC is recommended to distinguish serous endometrial intraepithelial carcinoma (SEIC) from its mimics.Level of evidence: IV,Strength of recommendation: A


Recommendation 3.5: A panel of markers must be used in cases where endocervical cancer is suspected. This panel should include at least ER, vimentin, CEA and p16 by IHC, and needs to be assessed in the histologic and clinical context. In addition, HPV analysis can be considered.Level of evidence: IV,Strength of recommendation: B


Recommendation 3.6: WT-1 by IHC is the recommended marker to determine the origin of serous cancer.Level of evidence: IV,Strength of recommendation: A



Recommendation 3.7: Morphology (and not IHC) should be used to distinguish AH/EIN from EEC.Level of evidence: IV,Strength of recommendation: A


To be continued…..

References:

Colombo N,Creutzberg CL, Amant F et al. ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27: 16–41.