A Novel Classification System for Patients with Endocervical Adenocarcinoma (EAC): The Impact of Tumor Growth Pattern on Lymph Node Metastasis
Isabel Alvarado-Cabrero, Kay J Park, Golnar Rasty, Sun Ran Hong, Jose G Chanona-Vilchis, Andrea Diaz De Vivar, Brent Arville, Denise A Barbuto, Joanne KL Rutgers, Andres A Roma, Rouba Ali-Fehmi, Norihiro Teramoto, Yoshiki Mikami, Elvio G Silva. Mexican Oncology Hospital, D.F., Mexico; Memorial Sloan-Kettering Cancer Center, New York, NY; University Health Network, Toronto, Canada; Cedars-Sinai Medical Center, Los Angeles, CA
Background: Currently, the resection of lymph nodes (LN) in cases of EAC depends mainly on the depth of invasion (DOI) of the tumor. However, it is well known that many factors can prevent pathologists from accurately measuring the DOI. The recently described Silva method (SM) (Gyn Oncol 2012;125:S27-S28) has shown that classifying EAC by pattern correlates better with the presence or absence of LN metastasis than using DOI. The objective of this study was determine whether the presence of lymphovascular invasion (LVI), tumor size, grade of differentiation, DOI and the new method provide prognostic information.
Design: 411 cases collected from 14 international institutions were analyzed. The evaluation of stromal invasion was conducted according to the SM.
Pattern A: well-demarcated glands (regardless of DOI) no lymphovacular invasion is allowed
Pattern B: early stromal invasion arising from well-demarcated glands
Pattern C: diffuse, destructive invasion.
Results: Ages ranged from 20 to 86 years (mean 45.9). The patterns of growth were A in 20% tumors, B in 25% and C in 55%. All patients were treated with lymphadenectomy, of them 8 pattern B cases and 58 pattern C cases had LN metastasis. All pattern B and pattern C cases with LN metastasis had LVI. The mean DOI of cases with pattern A and B was the same (5.3mm) and the mean DOI of cases with pattern C was 10mm. 42% percent of pattern A cases were ≤10mm in size compared to 26% and 6% of the tumors with a growth pattern B and C, respectively.
Conclusions: Analysis of additional cases following our initial study further validates our observation of the clinical utility of the pattern-based classification. There were no lymph node metastasis in cases with a growth pattern A. All pattern B and C cases with LN metastasis had LVI. If superficial invasion is found without obvious LVI careful examination of the pathology is recommended, including obtaining deeper sections because in our series of 102 cases with pattern B, only those with LVI had LN metastasis (7.8%) as well as 26% of pattern C cases.
Category: Gynecologic & Obstetrics
Tuesday, March 5, 2013 8:45 AM
Proffered Papers: Section E, Tuesday Morning