Invasive endocervical adenocarcinoma: proposal for a new pattern-based classification system with significant clinical implications: a multi-institutional study.
The management of endocervical adenocarcinoma is largely based on tumor size and depth of invasion (DOI); however, DOI is difficult to measure accurately. The surgical treatment includes resection of regional lymph nodes, even though most lymph nodes are negative and lymphadenectomies can cause significant morbidity. We have investigated alternative parameters to better identify patients at risk of node metastases. Cases of invasive endocervical adenocarcinoma from 12 institutions were reviewed, and clinical/pathologic features assessed: patients' age, tumor size, DOI, differentiation, lymph-vascular invasion, lymph node metastases, recurrences, and stage. Cases were classified according to a new pattern-based system into Pattern A (well-demarcated glands), B (early destructive stromal invasion arising from well-demarcated glands), and C (diffuse destructive invasion). In total, 352 cases (FIGO Stages I-IV) were identified. Patients' age ranged from 20 to 83 years (mean 45), DOI ranged from 0.2 to 27 mm (mean 6.73), and lymph-vascular invasion was present in 141 cases. Forty-nine (13.9%) demonstrated lymph node metastases. Using this new system, 73 patients (20.7%) with Pattern A tumors (all Stage I) were identified. None had lymph node metastases and/or recurrences. Ninety patients (25.6%) had Pattern B tumors, of which 4 (4.4%) had positive nodes; whereas 189 (53.7%) had Pattern C tumors, of which 45 (23.8%) had metastatic nodes. The proposed classification system can spare 20.7% of patients (Pattern A) of unnecessary lymphadenectomy. Patients with Pattern B rarely present with positive nodes. An aggressive approach is justified in patients with Pattern C. This classification system is simple, easy to apply, and clinically significant.
Baylor College of Medicine (A.D.D.V.), Texas Children's Hospital Pavilion for Women The University of Texas MD Anderson Cancer Center (A.D.D.V., I.A.-B., E.G.S.), Houston, Texas Cleveland Clinic (A.A.R.), Cleveland, Ohio Memorial Sloan-Kettering Cancer Center (K.J.P.), New York, New York Mexican Oncology Hospital (I.A.-C.) Instituto Nacional de Cancerologia (Mexico) (J.G.C.-V.), Mexico City, Mexico University Health Network (G.R.), University of Toronto, Toronto Juravinski Hospital (D.D.), McMaster University, Hamilton, Ontario, Canada Kyoto University Hospital (Y.M.), Kyoto Shikoku Cancer Center (N.T.), Matsuyama, Japan Cheil General Hospital & Women's Healthcare Center (S.R.H.), Kwandong University, Gangneung, Korea Cedars-Sinai Medical Center (B.A., D.B., E.G.S.), Los Angeles Long Beach Memorial Medical Center (J.K.L.R.), University of California, Long Beach, California Wayne State University (R.A.-F., F.T.), Detroit, Michigan University Cancer Care (A.S.-B.), University of Mississippi Cancer Center, Jackson, Mississippi.
Andrea
A
Diaz De Vivar
Andres A
AA
Roma
Kay J
KJ
Park
Isabel
I
Alvarado-Cabrero
Golnar
G
Rasty
Jose G
JG
Chanona-Vilchis
Yoshiki
Y
Mikami
Sung R
SR
Hong
Brent
B
Arville
Norihiro
N
Teramoto
Rouba
R
Ali-Fehmi
Joanne K L
JK
Rutgers
Farah
F
Tabassum
Denise
D
Barbuto
Irene
I
Aguilera-Barrantes
Alexandra
A
Shaye-Brown
Dean
D
Daya
Elvio G
EG
Silva
D000230:Adenocarcinoma / Q000145:classification* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000145:classification* / Q000473:pathology / Q000601:surgery