Endometrial Hiperplazi ve Karsinomunda Nükleus Boyutunun Karşılaştırmalı Morfometrik Analizi

Yıl 2020, , 591 - 601, 30.12.2020

Ayşe Nur Uğur Kılınç , Sıddıka Fındık Pembe Oltulu

https://doi.org/10.26453/otjhs.776947

Öz

Amaç: Ülkemizde ve tüm dünyada sıklığı giderek artmakta olan endometrial karsinomların öncül lezyonları endometrial hiperplazilerdir. Histopatolojik özellikleri tanımlanmış olmasına rağmen kriterlerin objektif olmaması ve immünohistokimyasal tekniklerin sınırlı olması hiperplazi olgularında gözlemciler arasında uyumsuzluk ortaya çıkarmaktadır.
Çalışmamızda atipili ve atipisiz endometrial hiperplazi ile atipili hiperplazi (EİN) ve Grade-I karsinomlarda gland epitel hücrelerinde en kısa nukleus çapı (NKÇ) ölçülerek gözlemciler arasındaki varyasyonlarını en aza indirmek için tanıya yardımcı olabilecek farklılık ve oran bulmayı amaçladık.

Materyal ve Metot: Çalışmamıza; küretaj ve histerektomi materyallerinde proliferatif endometrium, endometrial hiperplazi ve adenokarsinom tanısı almış 100 vaka dahil edildi. Her bir olguda 50 adet gland epitel hücresi nükleuslarının en kısa çapı görüntü analiz programı ile (BAB Bs200Pro Image Analysis Software) manuel olarak ölçüldü.

Bulgular: İkili grupların karşılaştırılmasında EİN'in glandüler epitel NKÇ’si ile atipik hiperplazi (AH)'nin glandüler epitel NKÇ’si, AH'nin glandüler epitel NKÇ'si ile proliferatif endometirum (PE)'nin glandüler epitel NKÇ'si arasındaki karşılaştırmalar dışında, tüm ikili karşılaştırmalarda istatistiksel olarak anlamlı derecede farklılık bulunmuştur (p <0,01).

Sonuç: Çalışmamızda ortaya çıkan nükleus çapları ile ilgili oran ve kıyaslamaların rutin ışık mikroskobu ile histopatolojik incelemede ilave ekipman gerekmeden öngörülerde bulunduğu için pratik uygulamalarda faydalı olabileceğini düşünüyoruz.

Anahtar Kelimeler

endometrial hiperplazi, morfometrik analiz, endometrial intraepitelyal neoplazi

Destekleyen Kurum

Yok

Proje Numarası

Yok

Teşekkür

Yok

Comparative Morphometric Analysis of Nucleus Size in Endometrial Hyperplasia and Carcinoma

Öz

Objective: Endometrial hyperplasias are the preliminary lesions of endometrial carcinomas. Although the histopathologic features are well-defined, the criteria are not objective and the immunohistochemical techniques are limited, resulting in inconsistency between the observers in cases of hyperplasia. Our study aimed to measure and compare the shortest nuclear diameter (SND) of gland epithelial cells; to find differences and ratios that may help to minimize variations among observers.

Materials and Methods: Our study included 100 cases diagnosed as proliferative endometrium (PE), endometrial hyperplasia, and endometrioid carcinoma from their curettage and hysterectomy materials. For each case, the shortest diameter of 50 gland epithelial cell nuclei was manually measured with an image analysis program (BAB Bs200 Pro Image Analysis Software).

Results: Comparison of binary groups revealed that except the comparisons between glandular epithelial SNDM of EIN (endometrial intraepithelial neoplasia) and glandular epithelial SNDM of AH (atypical hyperplasia), and glandular epithelial SNDM of AH and glandular epithelial SNDM of PE all comparisons were statistically significantly different (p<0.01).

Conclusion: We think that the ratios and comparisons related to nucleus diameters obtained in our study may be useful in practical applications because predictions can be made with routine light microscopy and histopathological examination.

Anahtar Kelimeler

endometrial hyperplasia,, morphometric analysis, endometrial intraepithelial neoplasia

Proje Numarası

Yok

Kaynakça

• Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1. 0, Cancer incidence and mortality worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency For Research On Cancer. 2012;11. doi:10.1002/ijc.29210
• Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics. Cancer Journal For Clinicians. 2018;68(5):329-339. doi: 10.3322/caac.21208
• Kurman RJ, Kaminsk PF, Norris HJ. The behavior of endometrial hyperplasia. A long‐term study of “untreated” hyperplasia in 170 patients. Cancer. 1985;56(2):403-412.
• Emons G, Beckmann MW, Schmidt D, Mallmann P. Uterus commission of the Gynecological Oncology Working Group (AGO). New WHO Classification of Endometrial Hyperplasias. Geburtshilfe Frauenheilkd. 2015;75(2):135-136. doi:10.1055/s-0034-1396256
• Collan Y. Diagnostic morphometry: Relevant background to decision making in diagnostic histopathology Science on Form: Proceedings of the First International Symposium for Science on Form. KTK Scientific Publishers, Tokyo. 1986;533-542.
• Sørensen FB. Quantitative analysis of nuclear size for prognosis-related malignancy grading. Advances in Oncobiology. 1996;1:221-255. doi :10.1016/S1569-254X(96)80013-6
• Pell R, Oien K, Robinson M, et al. The use of digital pathology and image analysis in clinical trials. Journal of Pathological Clinical Research. 2019;5:81-90. doi:10.1002/cjp2.127
• Nunes T, Filippi-Chiela E, Callegari-Jacques S, et al. Nuclear morphometric analysis in tissue as an objective tool with potential use to improve melanoma staging. Melanoma Research. 2019;29(5):474-482 doi: 10.1097/CMR.0000000000000594
• Yang W, Tian R, Xue T. Nuclear shape descriptors by automated morphometry may distinguish aggressive variants of squamous cell carcinoma from relatively benign skin proliferative lesions: a pilot study. Tumour Biology. 2015;36:6125–6131. doi: 10.1007/s13277-015-3294-5
• Hoque A, Lippman SM, Boiko IV, et al. Quantitative nuclear morphometry by image analysis for prediction of recurrence of ductal carcinoma in situ of the breast. Cancer Epidemiology, Biomarkers&Prevention. 2001;10:249–259.
• Vukovic LD, Jevtic P, Edens LJ, Levy DL. New insights into mechanisms and functions of nuclear size regulation. International Review of Cell and Molecular Biology. 2016;322:1–59. doi: 10.1016/bs.ircmb.2015.11.001
• Downing MJ, Papke DJ, Tyek S, Mutter GL. A New Classification of Benign, Premalignant, and Malignant Endometrial Tissues Using Machine Learning Applied to 1413 Candidate Variables. International Journal of Gynecological Pathology. 2020;39(4):333-343. doi: 10.1097/PGP.0000000000000615
• Malpica A, Michael TD, Euscher E. Biopsy interpretation of the uterine cervix and corpus. 1nd edition Lippincott Williams & Wilkins, 2009;177.
• Skaarland E, Nuclear size and shape of epithelial cells from the endometrium: lack of value as a criterion for differentiation between normal, hyperplastic, and malignant conditions. Journal of Clinical Pathology. 1985;38(5):502-506. doi: 10.1136/jcp.38.5.502
• Baak JP, Nauta, JJP, Wisse‐Brekelmans ECM, Bezemer PD. Architectural and nuclear morphometrical features together are more important prognosticators in endometrial hyperplasias than nuclear morphometrical features alone. The Journal of Pathology. 1988;154(4):335-341. doi: 10.1002/path.1711540409
• Dunton CJ, Baak JP, Palazzo JP, van Diest PJ, McHugh M, Widra EA. Use of computerized morphometric analyses of endometrial hyperplasias in the prediction of coexistent cancer. American Journal Of Obstetrics And Gynecology. 1996;174(5):1518-1521. doi: 10.1016/s0002-9378(96)70599-9
• Mahovlić V, Ovanin RA, Škopljanac ML, et al. Digital morphometry of cytologic aspirate endometrial samples. Collegium Antropologicum. 2010;34(1):45-51.
• Toy H, Etli O, Celik ZE, Alikanoglu AS. Associations between nucleus size, and immunohistochemical Galectin-3, Cytokeratine-19 and Hbme-1 markers in thyroid papillary carcinoma: a morphometric analyze. Pathology & Oncology Research. 2019;25(1):401-408.
• Deans GT, Hamilton PW, Watt PCH, et al. Morphometric analysis of colorectal cancer. Diseases of the Colon & Rectum. 1993;36:450–456. doi: 10.1007/BF02050010
• Celik ZE, Altinay S, Kilinc F, et al. Using Computerized Cytomorphometry to Distinguish between Benign and Malignant Cases in Thyroid Fine‐Needle Aspiration Cytology. Diagn. Cytopathol. 2016;44:902-911. doi:10.1002/dc.23611