Two-Antibody Staining Method, A Cost-Saving Strategy for Universal Lynch Syndrome Screening in Endometrial Cancers


  • Natthakrit Anansitthikorn Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
  • Suchanan Hanamornroongruang Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok



Endometrial carcinoma, lynch syndrome, MMR proteins, MSH2 loss


Objective: Lynch syndrome is an autosomal dominant disorder that increases the risk of cancers in many sites. In women, endometrial cancer is often a sentinel tumor and thus immunohistochemistry for mismatch repair (MMR) proteins MLH1, MSH2, MSH6 and PMS2 is encouraged as a screening test. To reduce cost, staining for only 2 MMR proteins PMS2 and MSH6 has been proposed. This study aimed to determine whether a 2-antibody staining test is enough to screen for Lynch syndrome in endometrial cancer patients.
Materials and Methods: Cases of endometrial carcinoma with immunohistochemistry for 4 MMR proteins were reviewed. Results of immunohistochemistry screening were compared between all four antibodies and only two (PMS2 and MSH6) antibodies.
Results: Loss of expression of any MMR proteins was detected in 51 out of 203 cases (25.12%). Twenty-three cases (45%) showed loss of MLH1 and PMS2; 13 cases (25%) showed loss of MSH2 and MSH6; five cases (10%) showed loss of MSH6; seven cases (14%) showed loss of PMS2 and three cases (6%) showed loss of MSH2. The 2-antibody method detected 48 cases (94%) with a MMR deficiency but failed to detect three cases (6%) with an isolate loss of MSH2. The screening results from the 2-antibody method are 98.5% (200/203) in accordance with the original 4-antibody method.
Conclusion: The 2-antibody method is a quite effective option to screen for Lynch syndrome in endometrial cancers. However, MSH2 mutations may be missed in a few cases.


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How to Cite

Anansitthikorn, N. ., & Hanamornroongruang, S. . (2022). Two-Antibody Staining Method, A Cost-Saving Strategy for Universal Lynch Syndrome Screening in Endometrial Cancers. Siriraj Medical Journal, 74(2), 108–113.



Original Article