Assessment of p53 in Endometrial Carcinoma Biopsy and Corresponding Hysterectomy Cases in a Real-World Setting: Which Cases Need Molecular Work-Up?

Abstract

Endometrial cancer can be classified based on molecular markers, including the tumor suppressor p53 protein, which plays a key role in regulating cell division and predicting patient outcomes. This study evaluated how well p53 immunohistochemistry (IHC), a common lab test, reflects the actual TP53 gene status and whether the test results are interpreted consistently across different pathologists. Five pathologists analyzed 2 types of tissue samples—98 biopsy and 86 hysterectomy samples—with genetic testing performed in all cases. When all five experts agreed on the IHC results, they matched 100% with genetic testing. However, in up to one-third of cases, molecular testing was needed for a clearer answer. Accuracy was higher among experienced pathologists. The findings indicate that p53 IHC, with proper training, can be a reliable method for assessing the status of the p53 tumor suppressor. Still, molecular testing remains essential when IHC results are unclear to ensure accurate diagnosis and guide appropriate treatment decisions.