Histopathologic predictors of the behavior of surgically treated stage IB squamous cell carcinoma of the cervix a gynecologic oncology group study

Abstract

Disagreement persists about the superiority of Reagan and Ng's method over that of Broders' for the histologic grading of squamous carcinoma of the cervix. Uncertainty about the predictive value and reproducibility of any of the grading methods prompted a comparison of factors previously suggested as indicating the biologic behavior for cervical squamous carcinoma. One hundred ninety‐five women, who were enrolled in a Gynecologic Oncology Group treatment protocol of Stage IB squamous carcinoma of the cervix and underwent radical hysterectomy with pelvic and paraaortic node sampling, formed the study population. The tumors were graded first by participating institutional pathologists, with submitted slides subjected to an independent review by two pathologists (R.J.Z. and S.W.). The histologic parameters examined included the presence and amount of keratinization, nuclear pleomorphism, mitotic rate, gestalt grading, pattern of invasion at the stromal interface, and inflammatory cell infiltrate. The depth of invasion and presence or absence of vascular invasion also were assessed. The probability of pelvic lymph node metastasis and the progression‐free interval were determined for each parameter. Surprisingly, none of the grading methods was effective in predicting nodal spread or progression‐free interval. However, an increasing depth of invasion strongly correlated with nodal spread and a diminished progression‐free interval (P < 0.0001). Vascular invasion was less effective in these predictions (0.05 < P < 0.10). Both measurements were reasonably reproducible. It was concluded that histologic grading of surgically treated cervical carcinoma is not useful but that the depth of invasion and vascular invasion are important predictors of behavior that should be reported routinely.

Clinical significance of tumor volume and lymph node involvement assessed by MRI in stage IIB cervical cancer patients treated with concurrent chemoradiation therapy

“…Increasing tumor size and increasing depth of stromal invasion correlated most strongly with LN metastasis and a shorter disease-free survival in previous studies of patients with FIGO stage 1B. 3,13 The accuracy and sensitivity rates with MRI for detecting LN metastasis from cervical cancer are between 76 to 100% and 36 to 71%, respectively. 14,15 However, the limitation of MRI is that it is not possible to differentiate metastatic LN from non-metastatic LN hyperplasia of similar size and shape.…”

Value of pelvic examination and imaging modality for the evaluation of tumor size in cervical cancer

“…Since some pathologic parameters are related to patients' prognosis, these parameters affect the plan of further treatment. [4][5][6] This means that pathologic findings of surgical specimens are important for the management of patients with cervical cancer. However, clinicians should consider preoperative diagnosis, because the stage of cervical cancer is clinically determined and clinicians can get much information related with prognosis from preoperative diagnosis.…”

“…However, postoperative adjuvant therapy should be considered if pathologic findings demonstrate risk factors including lymph node metastases, deep cervical invasion, positive resection margin, parametrial invasion and bulkiness of tumor. [2][3][4] Among them, parametrial invasion and tumor size are evaluated by preoperative pelvic examination.…”

What is your diagnosis?

“…These include: volume and grade of tumor, histologic type, lymphatic spread, and vascular invasion. In a large surgicopathologic staging study of patients with clinical stage IB disease reported by the Gynecologic Oncology Group, the factors that predicted most prominently for lymph node metastases and a decrease in disease-free survival were capillarylymphatic space involvement by tumor, increasing tumor size, and increasing depth of stromal invasion, with the latter being most important and reproducible (2,3). In a study of 1.028 patients treated with radical surgery, survival rates correlated more consistently with tumor volume (as determined by precise volumetry of the tumor) than clinical or histologic stage (4).The preoperative diagnosis of tumor geography may play an important role in management of cervical cancer.…”