Endocervical involvement in endometrial adenocarcinoma is not prognostically significant and the pathologic assessment of the pattern of involvement is not reproducible.
OBJECTIVE
Since 1988, cervical gland involvement and stromal invasion defined stage IIA and stage IIB endometrial carcinoma. In 2009, FIGO changed the criteria for stage II disease to include only those with cervical stromal invasion. We wished to: 1) assess the reproducibility of pathologists to distinguish patterns of cervical spread, and 2) determine the prognostic significance of cervical involvement.


METHODS
Slides from 46 women with cervical involvement by endometrial adenocarcinoma were scored for 5 patterns of involvement by 6 experienced pathologists to determine reproducibility. To assess prognostic significance, 206 patients with FIGO 1988 stage II adenocarcinoma formed the study population with matched FIGO stage I controls.


RESULTS
At least 5 of the 6 pathologists agreed that the cervix was involved in the 46 cases. The reproducibility for cervical gland involvement and endocervical stromal invasion was slight (kappas of 0.15 and 0.28). The survival with any type of cervical involvement was not significantly different from that of matched stage I controls (p=0.18). The 5year recurrence-free survival rates were 84% for FIGO 1988 stage I, 73% for stage IIA, and 82% for stage IIB (FIGO 2009 stage II).


CONCLUSIONS
Pathologists reliably recognize cervical involvement by endometrial carcinoma. However, reproducibility for the determination of pattern of cervical spread by experienced pathologists is too low to be of clinical utility. Women with spread of carcinoma to the cervix do not have a significantly lower survival than matched stage I controls. Cervical spread should not be the basis for determination of stage II disease.
Department of Pathology and the Cancer Institute, MS Hershey Medical Center, Penn State University, Hershey, PA, USA. Electronic address: rzaino@hmc.psu.edu.
Richard J
RJ
Zaino
Department of Pathology and the Cancer Institute, MS Hershey Medical Center, Penn State University, Hershey, PA, USA.
Catherine
C
Abendroth
Department of Pathology, Johns Hopkins Medical Institution, Baltimore, MD, USA.
Anna
A
Yemelyanova
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Esther
E
Oliva
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Diana
D
Lim
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Robert
R
Soslow
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Deborah
D
DeLair
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Ian S
IS
Hagemann
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Kathleen
K
Montone
Department of Public Health Sciences, MS Hershey Medical Center, Penn State University, Hershey, PA, USA.
Junjia
J
Zhu
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology*; D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results