{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:09:01Z","timestamp":1766995741896,"version":"3.48.0"},"reference-count":20,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,27]],"date-time":"2025-12-27T00:00:00Z","timestamp":1766793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Mismatch repair (MMR) and microsatellite instability (MSI) testing have become essential biomarkers in the molecular classification of endometrial cancer (EC), guiding adjuvant treatment decisions and eligibility for immune checkpoint inhibition. Although international guidelines recommend universal testing, real-world implementation remains heterogeneous. This study aimed to evaluate trends in MMR and MSI testing and associated molecular diagnostics in Germany between 2018 and 2022. Methods: A retrospective multicenter analysis was conducted across German tertiary care centers. Data from patients with histologically confirmed EC between 2018 and 2022 were extracted from standardized electronic pathology records. Annual testing rates for MSI, MMR, POLE, TP53, and L1CAM were analyzed using descriptive statistics and trend analysis (Chi-square test for trend, p &lt; 0.05). Therapeutic data were collected to assess the use of immune checkpoint inhibitors. Results: There was a significant increase in the annual rates of molecular testing for MSI, POLE, TP53, and L1CAM over the five-year observation period (all p &lt; 0.05). TP53 testing showed the highest increase (13.1% \u2192 78.6%), while MSI testing rose from 82.9% to 97.4%. Both POLE and L1CAM testing were virtually absent in 2018 (0% and 1.6%) but reached 15.7% by 2022. Conclusions: This study demonstrates a rapid and substantial implementation of MMR and MSI testing in German clinical practice, reflecting successful translation of trial results into routine care. However, implementation of testing in guidelines appeared time-shifted. For bridging this gap, annual guideline updates seem to be necessary.<\/jats:p>","DOI":"10.3390\/diagnostics16010100","type":"journal-article","created":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T23:54:36Z","timestamp":1766966076000},"page":"100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Microsatellite Instability Status and Mismatch Repair Defects Testing in Endometrial Cancer\u2014Insights from the Multicenter E-PEC Trial"],"prefix":"10.3390","volume":"16","author":[{"given":"B\u00fcsra","family":"Eser","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Medical Faculty, University Hospital of Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Papior","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Medical Faculty, University Hospital of Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6766-8297","authenticated-orcid":false,"given":"Jon","family":"Salmanton-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany"},{"name":"Clinical Trials Centre Cologne (ZKS K\u00f6ln), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany"},{"name":"Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, 50931 Cologne, Germany"},{"name":"Department I of Internal Medicine, European Confederation for Medical Mycology (ECMM) Excellence Center, University of Cologne, 50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9599-3137","authenticated-orcid":false,"given":"Oliver A.","family":"Cornely","sequence":"additional","affiliation":[{"name":"Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany"},{"name":"Clinical Trials Centre Cologne (ZKS K\u00f6ln), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany"},{"name":"Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, 50931 Cologne, Germany"},{"name":"Department I of Internal Medicine, European Confederation for Medical Mycology (ECMM) Excellence Center, University of Cologne, 50931 Cologne, Germany"},{"name":"German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, 50931 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-0079","authenticated-orcid":false,"given":"Bernd","family":"Morgenstern","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Gynecologic Oncology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, D\u00fcsseldorf), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5955-8602","authenticated-orcid":false,"given":"Clarissa","family":"Herpel","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Gynecologic Oncology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, D\u00fcsseldorf), Faculty of Medicine, University Hospital Cologne, University of Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2024-2907","authenticated-orcid":false,"given":"Julia C.","family":"Radosa","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital of Homburg, 66424 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anas","family":"Almuheimid","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital of Homburg, 66424 Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5474-051X","authenticated-orcid":false,"given":"Bahriye","family":"Aktas","sequence":"additional","affiliation":[{"name":"Department of Gynecology, University Hospital of Leipzig, 04103 Leipzig, Germany"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5216-3547","authenticated-orcid":false,"given":"Laura","family":"Weydandt","sequence":"additional","affiliation":[{"name":"Department of Gynecology, University Hospital of Leipzig, 04103 Leipzig, Germany"},{"name":"Comprehensive Cancer Center Central Germany, Partner Site Leipzig, 04103 Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1841-4207","authenticated-orcid":false,"given":"Julia","family":"Wittenborn","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, D\u00fcsseldorf), University Hospital of RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9853-0004","authenticated-orcid":false,"given":"Philipp","family":"Meyer-Wilmes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, D\u00fcsseldorf), University Hospital of RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Friebe","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital of D\u00fcsseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane","family":"Leidinger","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital of D\u00fcsseldorf, 40225 D\u00fcsseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer","family":"Kimmig","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Medical Faculty, University Hospital of Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1458-7303","authenticated-orcid":false,"given":"Fabinshy","family":"Thangarajah","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Medical Faculty, University Hospital of Essen, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,27]]},"reference":[{"key":"ref_1","first-page":"7","article-title":"Cancer statistics, 2020","volume":"70","author":"Siegel","year":"2020","journal-title":"CA Cancer J. 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