子宫内膜活检中经常会遇到不符合子宫内膜样上皮内瘤变 (EIN) 诊断标准的腺体拥挤区域。在这项研究中，我们记录了这些亚诊断病变 (SL) 患者肿瘤结局的患病率，并评估了形态学特征和三标记免疫组织化学组合（PAX2、PTEN、β-连环蛋白）预测结局的效用。 430 名女性中2001 年至 2021 年间，在布莱根妇女医院对子宫内膜取样进行 SL 检测并进行后续活检后，72 例 (17%) 出现肿瘤结果（EIN 或子宫内膜样癌）。 SL 中的多层上皮和有丝分裂与肿瘤结果具有统计学相关性。在 93%（57 名中的 53 名）具有肿瘤性结果的 SL 中观察到异常三标记染色，60%（62 名中的 37 名）具有良性结果的对照组观察到异常三标记染色。在 72 名出现肿瘤结果的患者中，33 名患者可获得 EIN/癌组织；其中，30 个 (91%) 显示一种或多种标记物染色异常。值得注意的是，在这些病例中 84% 的 EIN/癌具有先前 SL 中所见的异常表达。基于 17% 的患病率，一种或多种标记物异常染色的阳性和阴性预测值分别为 24% 和 97%。 SL 的存在值得临床监测和重复采样，因为在显着的情况下，SL 的存在会导致子宫内膜样瘤形成。患者的子集。正常的三标记染色可识别肿瘤结果风险极低的女性。相反，异常染色在 SL 中很常见，良性结果导致特异性和阳性预测值较差。© 2024 John Wiley

Areas of gland crowding that do not fulfil diagnostic criteria of endometrioid intra-epithelial neoplasia (EIN) are often encountered in endometrial biopsies. In this study, we document the prevalence of neoplastic outcome in patients with these subdiagnostic lesions (SL) and assess the utility of morphological features and a three-marker immunohistochemistry panel (PAX2, PTEN, beta-catenin) to predict outcome.Of 430 women with SL on endometrial sampling at Brigham and Women's Hospital between 2001 and 2021 with available follow-up biopsy, 72 (17%) had a neoplastic outcome (EIN or endometrioid carcinoma). Multilayered epithelium and mitoses in SL were statistically associated with a neoplastic outcome. Abnormal three-marker staining was observed in 93% (53 of 57) of SL with neoplastic outcome and 60% (37 of 62) of a control group with benign outcome. Among the 72 patients with neoplastic outcome, EIN/carcinoma tissue was available in 33; of these, 30 (91%) showed abnormal staining for one or more markers. Remarkably, in 84% of these cases the EIN/carcinoma had the aberrant expression seen in the preceding SL. Based on a prevalence of 17%, the positive and negative predictive values of abnormal staining in one or more markers were 24 and 97%, respectively.The presence of SL warrants clinical surveillance and repeat sampling because it is followed by endometrioid neoplasia in a significant subset of patients. Normal three-marker staining identifies women with a very low risk of neoplastic outcome. Conversely, abnormal staining is frequent in SL with benign outcome leading to poor specificity and positive predictive value.© 2024 John Wiley & Sons Ltd.