Significance of Three-Marker Panel of PAX2, PTEN and Beta-catenin in The Diagnosis of Endometrial Precancers

Background: Endometrial hyperplasia (EH) is a lesion that precedes endometrioid endometrial carcinoma (type 1 EC). Pathologists are aware of the practical challenges associated with accurate atypical hyperplasia/endometrioid intraepithelial neoplasia (AH/EIN) diagnosis. Numerous researchers have concentrated on biomarkers that can forecast the likelihood of progression from endometrial hyperplasia to EC. In order to differentiate AH/EIN from its mimics, the objective of this work is to assess the expression of PAX2, PTEN, and beta-catenin both separately and in combination. Methods: This is a case control study that included sixty cases divided into three groups (20 in each group): control group (normal ovulatory cycling endometrium (proliferative and secretory)), EH without atypia, and AH/EIN. Formalin-fixed paraffin-embedded tissue sections were analyzed immunohistochemically for PAX2, PTEN, and beta-catenin. Results: The performance characteristics of each marker, the entire panel, and subsets thereof were quantitatively and statistically analyzed. In order of number of cases detected, the most frequently aberrant markers in AH/EIN were Pax2 (80% of cases) with specificity (80%), PTEN (45% of cases) with specificity (85), and B-catenin (40% of cases) with specificity (100%) in distinguishing AH/EIN. Regarding the relationship between three markers in detecting AH/EIN, using β-catenin in addition to PAX2 raises the sensitivity to 90% with specificity (80%). But using a three-marker panel raises sensitivity (95%) with specificity (80%). While using PTEN and B-catenin had the lowest sensitivity (75%). Conclusions: Three-marker panel of PAX2, PTEN and B-catenin is significant in differentiation AH/EIN from its benign mimics (EH without atypia).