Enriching Personalized Endometrial Cancer Research with the Harmonization of Biobanking Standards

Abstract

Endometrial cancer is the commonest gynecological cancer, with an incidence predicted to escalate by a further 50-100% before 2025, due to the rapid rise in risk factors such as obesity and increased life expectancy. Endometrial cancer associated mortality is also rising, depicting the need for translatable research to improve our understanding of the disease. Rapid translation of scientific discoveries will facilitate the development of new diagnostic, prognostic and therapeutic strategies. Biobanks play a vital role in providing biospecimens with accompanying clinical data for personalized translational research. Wide variation in collection, and pre-analytic variations in processing and storage of bio-specimens result in divergent and irreproducible data from multiple studies that are unsuitable for collation to formulate robust conclusions. Harmonization of biobanking standards is thus vital, in facilitating international multi-center collaborative studies with valuable outcomes to improve personalized treatments. This review will detail the pitfalls in the biobanking of biosamples from women with cancer in general, and describe the recent international harmonization project that developed standardized research tools to overcome these challenges and to enhance endometrial cancer research, which will facilitate future development of personalized novel diagnostic strategies and treatments.

Keywords: biobanking; biospecimens; endometrial cancer; harmonization; translational research.

Figure 1

Micrographs of endometrial biopsies obtained during diagnostic procedures from patients with endometrial cancer. Pipelle (upper panel) and curettage (lower panel) samples may contain either satisfactory or inadequate amounts of cancer tissue as shown in this Haematoxylin- and Eosin-stained formalin fixed and paraffin-embedded tissue sections. This may be due to the skill of the clinician obtaining the sample, the endometrial thickness and the presence of mucus/blood, but they are inherent and unpredictable problems associated with these methods. Therefore, when a sample is collected by using these methods, and it is directly assigned for genomic and proteomic studies without confirming their cellular/tissue content, they may not produce credible data.

Figure 1

Micrographs of endometrial biopsies obtained during diagnostic procedures from patients with endometrial cancer. Pipelle (upper panel) and curettage (lower panel) samples may contain either satisfactory or inadequate amounts of cancer tissue as shown in this Haematoxylin- and Eosin-stained formalin fixed and paraffin-embedded tissue sections. This may be due to the skill of the clinician obtaining the sample, the endometrial thickness and the presence of mucus/blood, but they are inherent and unpredictable problems associated with these methods. Therefore, when a sample is collected by using these methods, and it is directly assigned for genomic and proteomic studies without confirming their cellular/tissue content, they may not produce credible data.

Figure 2

Micrographs of three separate endometrial samples obtained from the same patient, containing normal endometrial glands, hyperplastic glands and frank endometrial cancer tissue. The exact pathology included in the part of the sample studied with high throughput methods will directly influence the data generated. As shown here, the three separate parts of the endometrium biopsied from the same hysterectomy sample contained a histologically different pathological phenotype in the epithelial cells.

Figure 3

Journey of a biospecimen. Schematic representation of the utility of the tools developed with the HASTEN study (Harmonization of biobAnking STandards in Endometrial caNcer research). ECPD: Endometrial cancer patient data tool, ECSD: Endometrial cancer surgical data tool, ECBS: Endometrial cancer biospecimen tool, SOP-ECBS: Standard operating procedure for endometrial cancer biospecimens (Adishesh et al. BJC 2018).