TY - JOUR
T1 - Invasive endocervical adenocarcinoma
T2 - Proposal for a new pattern-based classification system with significant clinical implications: A multi-institutional study
AU - De Vivar, Andrea Diaz
AU - Roma, Andres A.
AU - Park, Kay J.
AU - Alvarado-Cabrero, Isabel
AU - Rasty, Golnar
AU - Chanona-Vilchis, Jose G.
AU - Mikami, Yoshiki
AU - Hong, Sung R.
AU - Arville, Brent
AU - Teramoto, Norihiro
AU - Ali-Fehmi, Rouba
AU - Rutgers, Joanne K.L.
AU - Tabassum, Farah
AU - Barbuto, Denise
AU - Aguilera-Barrantes, Irene
AU - Shaye-Brown, Alexandra
AU - Daya, Dean
AU - Silva, Elvio G.
PY - 2013/11
Y1 - 2013/11
N2 - 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.
AB - 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.
KW - Invasive endocervical adenocarcinoma
KW - Lymph node metastasis
KW - New pattern
KW - based classification system
UR - http://www.scopus.com/inward/record.url?scp=84886085152&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84886085152&partnerID=8YFLogxK
U2 - 10.1097/PGP.0b013e31829952c6
DO - 10.1097/PGP.0b013e31829952c6
M3 - Article
C2 - 24071876
AN - SCOPUS:84886085152
VL - 32
SP - 592
EP - 601
JO - International Journal of Gynecological Pathology
JF - International Journal of Gynecological Pathology
SN - 0277-1691
IS - 6
ER -