In the WHO and ESGO molecular classification of endometrial carcinoma, the order of assignment matters. A pathogenic POLE exonuclease-domain mutation places the tumour in the POLE-mutated group first; if absent, mismatch repair deficiency defines the MMR-deficient group; only then does abnormal p53 define the p53-abnormal group, and the rest are no specific molecular profile. A tumour with both POLE mutation and abnormal p53 is therefore classified as POLE-mutated. Reporting all results, including secondary ones, keeps the record complete.
- Assign POLE-mutated status first, then MMR deficiency, then p53 abnormality.
- Classify a tumour with POLE mutation and abnormal p53 as POLE-mutated.
- Report every molecular result, not only the one that decides the class.
- State in the report when POLE testing was not performed, as the class is then provisional.
Why it matters
Multiple-classifier tumours are classified wrongly when the order is not followed.
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