Abstract

This study was conducted to establish a correlation between endometrial thickness and Ki-67 expression in endometrial pathologies, correlate endometrial thickness and Ki-67 expression in endometrial pathologies and evaluate the diagnostic utility of this correlation for early diagnosis of premalignant and malignant lesions, which in turn means treatment optimization. METHODS: This was a hospital-based prospective study conducted among 100 patients who presented with abnormal uterine bleeding at the Department of Pathology, Niloufer Hospital, Red Hills, Hyderabad, over a period of two years from 2020 to 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. RESULTS: Out of 100 cases, a maximum of 32% were diagnosed as endometrial hyperplasia without atypia. The least number of cases 0.3% were of endometrial carcinoma. The highest number of cases 39 (39%)-belonged to the endometrial thickness range of 11–15 mm, closely followed by the number of cases 38 (38%) with endometrial thickness between 6 and 10 mm. The mean Ki-67 LI and mean endometrial thickness for each histological entity were evaluated, and these two parameters were found to be highest in endometrial carcinoma (ET = 17.4 mm and Ki-67 LI = 38%). There was an incremental increase noted in the Ki-67 LI along the hyperplasia-to Carcinoma sequence, with Ki-67 LI being 19% in hyperplasia without atypia, 28% in atypical hyperplasia/EIN and 38% in endometrial carcinoma. Similarly, endometrial thickness also increased from 11.7 mm in hyperplasia without atypia to 14.8 mm in atypical hyperplasia or EIN and 17.4mm in endometrial carcinoma. Ki-67 LI and endometrial thickness were found to be positively correlated in cases of hyperplasia without atypia, atypical hyperplasia, carcinoma, and cystic endometrium. Our study showed a strong positive, statistically significant correlation between Ki-67 and endometrial thickness. CONCLUSION: In endometrial pathologies, Ki-67 has established prognostic significance and predictive value, and its role as an ancillary tool along with other immunomarkers in the diagnosis and differentiation of endometrial hyperplasia and endometrial carcinoma has been documented in several studies. However, the standardisation of Ki-67 labelling index cutoff values in endometrial hyperplasia and carcinoma is yet to be established.

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