Invasive endocervical adenocarcinoma: Proposal for a new pattern-based classification system with significant clinical implications: A multi-institutional study

Andrea Diaz De Vivar, Andres A. Roma, Kay J. Park, Isabel Alvarado-Cabrero, Golnar Rasty, Jose G. Chanona-Vilchis, Yoshiki Mikami, Sung R. Hong, Brent Arville, Norihiro Teramoto, Rouba Ali-Fehmi, Joanne K.L. Rutgers, Farah Tabassum, Denise Barbuto, Irene Aguilera-Barrantes, Alexandra Shaye-Brown, Dean Daya, Elvio G. Silva

Research output: Contribution to journalArticle

53 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)592-601
Number of pages10
JournalInternational Journal of Gynecological Pathology
Volume32
Issue number6
DOIs
StatePublished - Nov 2013

Keywords

  • Invasive endocervical adenocarcinoma
  • Lymph node metastasis
  • New pattern
  • based classification system

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Obstetrics and Gynecology

Fingerprint Dive into the research topics of 'Invasive endocervical adenocarcinoma: Proposal for a new pattern-based classification system with significant clinical implications: A multi-institutional study'. Together they form a unique fingerprint.

Cite this