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Pax2 expression in simultaneously diagnosed WHO and EIN classification systems.

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PAX2 biomarker reliably identifies endometrial precancerous lesions using the endometrial intraepithelial neoplasia (EIN) classification. Its effectiveness is less certain with the 1994 WHO system, but it aids in diagnosing atypical hyperplasia.

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Area of Science:

  • Gynecologic pathology
  • Oncology
  • Biomarker research

Background:

  • PAX2 is a robust biomarker for endometrial precancerous lesions within the endometrial intraepithelial neoplasia (EIN) classification.
  • Its diagnostic utility is questionable when applied to the 1994 World Health Organization (WHO) classification system for distinguishing atypical and nonatypical hyperplasia.

Purpose of the Study:

  • To evaluate PAX2 staining patterns in endometrial samples classified by both the 1994 WHO criteria and the EIN scheme.
  • To compare the efficacy of PAX2 in differentiating precancerous endometrial lesions under different classification systems.

Main Methods:

  • Analyzed 67 precancerous endometrial cases classified using both 1994 WHO and EIN criteria by two gynecologic pathologists.
  • Assessed PAX2 staining in lesional tissue, comparing it to nonlesional background, and scoring alterations (loss, increase, decrease).

Main Results:

  • PAX2 alterations, particularly complete loss of nuclear staining (86.3%), strongly correlated with EIN diagnoses (92%) but less so with 1994 WHO classifications (88% atypical hyperplasia vs. 64% nonatypical hyperplasia).
  • PAX2 alterations were observed in 92% of EIN cases versus 15% of benign hyperplasia cases.
  • Adenocarcinoma was found in 45% of follow-up hysterectomies with prior PAX2-altered biopsies.

Conclusions:

  • PAX2 serves as a valuable adjunct stain and training tool for diagnosing atypical hyperplasia/EIN when features are ambiguous.
  • PAX2 staining alterations are highly indicative of endometrial intraepithelial neoplasia.
  • The utility of PAX2 is more pronounced with the EIN classification than the 1994 WHO system.