Utility of SOX2 in the diagnosis of squamous intraepithelial lesions and squamous cell carcinoma of cervix uteri

The objective of this study was to examine the association between SOX2 expression and diagnostic and prognostic data in precancerous and cancerous lesions of the cervix uteri. It was postulated that SOX2 immunohistochemistry has the potential to serve as a diagnostic marker for classifying squamous intraepithelial lesions and as a predictor of invasion. The immunohistochemical staining of SOX2 was investigated in 210 cervical biopsies obtained from the archives of the Pathology Department of Gaziantep University Faculty of Medicine between January 2017 and June 2022. The samples were grouped according to their diagnosis, namely benign (normal/squamous metaplasia) (n = 28), cervical intraepithelial neoplasia 1 (CIN1) (n = 50), cervical intraepithelial neoplasia 2 (CIN2) (n = 50), cervical intraepithelial neoplasia (CIN3) (n = 50) and squamous cell carcinoma (SCC) (n = 32). The correlation between the expression status and prognostic parameters was analyzed. The expression of SOX2 was observed in 62.5% of SCC cases, 70% of CIN3 cases and 26% of CIN2 cases. A statistically significant difference in expression was observed between the CIN1 and CIN2/3 groups and the noninvasive-invasive group. No significant correlation was identified between SOX2 expression and prognostic parameters in SCC group. A notable increase in SOX2 expression was evident as the lesions progressed from normal squamous epithelial cells to those exhibiting CIN1, CIN2, CIN3, and finally, SCC. The results of this study suggest that SOX2 may be utilized as a diagnostic tool to facilitate the differentiation between low grade squamous intraepithelial lesion (LSIL or CIN1) and high grade squamous intraepithelial lesion (HSIL or CIN2/CIN3). Moreover, it has the potential to assist in the differentiation of CIN2 from CIN3 and SCC in cases where the invasion is debatable.