Identification of the biologic outcome of grade II endometrial adenocarcinoma

Endometrial adenocarcinomas grade H share the same histological criteria, but have a heterogeneous biologic behaviour. Identification of risk groups is needed to improve patient management and outcome. This study included 36 paraffin embedded tumor specimens investigated for DNA ploidy by image analysis (IA) and flow cytometry (FCM). Proliferative activity was evaluated by measuring S-phase fraction (SPF) by FCM and proliferating cell nuclear antigen (PCNA) immunostaining. Aneuploidy was found in 38.9% and 25% of cases by IA and FCM respectively. Both techniques were reliable for ploidy analysis (p<0.001)with concordance in 80.6% of cases. However, IA was superior to FCM in detection of aneuploidy. A strong association was found between SPF and ploidy (p=0.01). The mean SPF was 8.9% in 74.1% of diploid tumors, as compared to a mean of 27.9% in 77.8% of aneuploid ones. Also, high PCNA expression was statistically correlated to high SPF (p=0.05). Moreover, PCNA correlates with aneuploidy by FCM and IA (p= 0.01, p< 0.001, respectively). By univariate analysis, ploidy (by IA or FCM); SPF and PCNA positivity showed a statistically significant correlation to survival. An aneuploid tumor with a high SPF is considered 'high risk', and a diploid one with low SPF is 'low risk'. A 'medium risk' group involves diploid tumors with high SPF.