title: New pattern-based personalized risk stratification system for endocervical adenocarcinoma with important clinical implications and surgical outcome.
abstract: We present a recently introduced three tier pattern-based histopathologic system to stratify endocervical adenocarcinoma (EAC) that better correlates with lymph node (LN) metastases than FIGO staging alone, and has the advantage of safely predicting node-negative disease in a large proportion of EAC patients. The system consists of stratifying EAC into one of three patterns: pattern A tumors characterized by well-demarcated glands frequently forming clusters or groups with relative lobular architecture and lacking destructive stromal invasion or lymphovascular invasion (LVI), pattern B tumors demonstrating localized destructive invasion (small clusters or individual tumor cells within desmoplastic stroma often arising from pattern A glands), and pattern C tumors with diffusely infiltrative glands and associated desmoplastic response. Three hundred and fifty-two cases were included; mean follow-up 52.8 months. Seventy-three patients (21%) had pattern A tumors; all were stage I and there were no LN metastases or recurrences. Pattern B was seen in 90 tumors (26%); all were stage I and LVI was seen in 24 cases (26.6%). Nodal disease was found in only 4 (4.4%) pattern B tumors (one IA2, two IB1, one IB not further specified (NOS)), each of which showed LVI. Pattern C was found in 189 cases (54%), 117 had LVI (61.9%) and 17% were stage II or greater. Forty-five (23.8%) patients showed LN metastases (one IA1, 14 IB1, 5 IB2, 5 IB NOS, 11 II, 5 III and 4 IV) and recurrences were recorded in 41 (21.7%) patients. This new risk stratification system identifies a subset of stage I patients with essentially no risk of nodal disease, suggesting that patients with pattern A tumors can be spared lymphadenectomy. Patients with pattern B tumors rarely present with LN metastases, and sentinel LN examination could potentially identify these patients. Surgical treatment with nodal resection is justified in patients with pattern C tumors.
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA. Electronic address: romaa@ccf.org.
authors.forename: Andres A
authors.initials: AA
authors.lastname: Roma
authors.affiliation: Baylor College of Medicine, Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: Toni-Ann
authors.initials: TA
authors.lastname: Mistretta
authors.affiliation: Baylor College of Medicine, Texas Children's Hospital Pavilion for Women, Houston, TX, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Diaz De Vivar
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kay J
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Mexican Oncology Hospital, Mexico City, Mexico.
authors.forename: Isabel
authors.initials: I
authors.lastname: Alvarado-Cabrero
authors.affiliation: University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Golnar
authors.initials: G
authors.lastname: Rasty
authors.affiliation: Instituto Nacional de Cancerologia (Mexico), Mexico City, Mexico.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Chanona-Vilchis
authors.affiliation: Kyoto University Hospital, Kyoto, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.affiliation: Cheil General Hospital & Women's Healthcare Center, Dankook University, Seoul, Republic of Korea.
authors.forename: Sung R
authors.initials: SR
authors.lastname: Hong
authors.affiliation: Shikoku Cancer Center, Matsuyama, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Teramoto
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Barbuto
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Joanne K L
authors.initials: JK
authors.lastname: Rutgers
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Elvio G
authors.initials: EG
authors.lastname: Silva
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D057285:Precision Medicine; D012306:Risk; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Classification system; Endocervical adenocarcinoma; Invasive carcinoma; Lymph node metastasis; Pattern-based; Risk stratification