[1224] Endocervical Adenocarcinoma – Proposal for a New Pattern-Based Classification System with Significant Clinical Implications: A Multi-Institutional Study

Kay J Park, Isabel Alvarado-Cabrero, Golnar Rasty, Sung R Hong, Jose G Chanona-Vilchis, Andrea Diaz De Vivar, Brent Arville, Denise A Barbuto, Joanne KL Rutgers, Andres A Roma, Rouba Ali-Fehmi, Farah Tabassum, Norihiro Teramoto, Yoshiki Mikami, Elvio G Silva. MSKCC, New York; Mexican Oncology Hosp, Mexico City, Mexico; Univ Health Network, Toronto, Canada; Kwangdong Univ, Seoul, Korea; Inst Nacional de Cancerologia, Mexico City, Mexico; MDACC, Houston; Cedars Sinai Med Cnt, Los Angeles; Long Beach Memorial Hosp, Irvine; Cleveland Clinic, Cleveland; Wayne State, Detroit; Shikoku Cancer Cnt, Ehime, Japan; Kyoto Univ, Kyoto, Japan

Background: The treatment of endocervical adenocarcinoma (EAC) is largely based on tumor depth of invasion (DOI); however, this crucial prognostic parameter is pathologically difficult to measure accurately or consistently. Greater than 95% of lymph nodes (LN) resected in EAC are negative, yet such aggressive LN dissections cause significant morbidity without obvious clinical benefit to patients, many of whom are at a young age. Therefore, we investigated other pathologic parameters that may better identify patients at risk of developing LN metastases.
Design: Cases diagnosed and treated as EAC from 12 institutions were reviewed. Clinical information and pathologic features were assessed, including: DOI, tumor size, LVI and pattern of tumor invasion using a newly devised system, defined as follows:
Pattern A = well-demarcated glands, regardless of DOI
Pattern B = early stromal invasion arising from well-demarcated glands
Pattern C = diffuse, destructive invasion
Results: 360 cases were identified (stage IA1 to IVB). Ages ranged from 20 to 83 years (mean 44.9) and DOI ranged from 0.5 to >40mm (mean 7.7mm). LVI was present in 145 cases.
Table 1 shows outcome data comparing the standard method of tumor evaluation (DOI) vs. the newly proposed pattern-based method:

Table 1

	Patients	Patients with Pos LN	Total LN	# Pos LN	Stage I	Stage II-IV
Standard Method	360	53 (15%)	8187	83 (1%)	327 (91%)	33 (9%)
Pattern A	79 (22%)	0	1651	0	79 (100%)	0
Pattern B	91 (25%)	7 (8%)	2153	11 (0.5%)	89 (98%)	2 (2%)
Pattern C	190 (53%)	46 (24%)	4383	72 (2%)	157 (83%)	33 (17%)

Pos= positive; LN=lymph nodes


Conclusions: 1- Classifying EAC by histologic pattern would identify 22% of patients who do not need lymph node resection (pattern A, all stage I disease).
2 - Patients with pattern B rarely have lymph node metastases and 98% have stage I disease.
3- Aggressive treatment should be offered to patients with pattern C since 24% of these patients have lymph node metastases and all patients with high stage disease have pattern C tumors.
4- This pattern-based classification of adenocarcinoma is simple, reproducible and clinically significant.
Category: Gynecologic & Obstetrics

Tuesday, March 20, 2012 1:00 PM

Platform Session: Section B, Tuesday Afternoon