Invasive endocervical adenocarcinoma: proposal for a new pattern-based classification system with significant
Andrea Diaz De Vivar1, Andres A Roma, Kay J Park
1Baylor College of Medicine (A.D.D.V.), Texas Children's Hospital Pavilion for Women The University of Texas MD Anderson Cancer Center (A.D.D.V., I.A.-B., E.G.S.), Houston, Texas Cleveland Clinic (A.A.R.), Cleveland, Ohio Memorial Sloan-Kettering Cancer Center (K.J.P.), New York, New York Mexican Oncology Hospital (I.A.-C.) Instituto Nacional de Cancerologia (Mexico) (J.G.C.-V.), Mexico City, Mexico University Health Network (G.R.), University of Toronto, Toronto Juravinski Hospital (D.D.), McMaster University, Hamilton, Ontario, Canada Kyoto University Hospital (Y.M.), Kyoto Shikoku Cancer Center (N.T.), Matsuyama, Japan Cheil General Hospital & Women's Healthcare Center (S.R.H.), Kwandong University, Gangneung, Korea Cedars-Sinai Medical Center (B.A., D.B., E.G.S.), Los Angeles Long Beach Memorial Medical Center (J.K.L.R.), University of California, Long Beach, California Wayne State University (R.A.-F., F.T.), Detroit, Michigan University Cancer Care (A.S.-B.), University of Mississippi Cancer Center, Jackson, Mississippi.
A new pattern-based classification for endocervical adenocarcinoma can identify low-risk patients. This system helps avoid unnecessary lymph node removal, improving patient outcomes and reducing surgical morbidity.
Area of Science:
- Gynecologic Oncology
- Surgical Pathology
- Cancer Classification
Background:
- Endocervical adenocarcinoma management relies on tumor size and depth of invasion (DOI), but DOI measurement is challenging.
- Current surgical treatment involves lymphadenectomy, despite most lymph nodes being negative, leading to significant morbidity.
Purpose of the Study:
- To investigate alternative parameters for identifying patients with endocervical adenocarcinoma at risk of lymph node metastasis.
- To develop and validate a novel pattern-based classification system for endocervical adenocarcinoma.
Main Methods:
- Retrospective review of 352 invasive endocervical adenocarcinoma cases from 12 institutions.
- Assessment of clinical and pathological features including age, tumor size, DOI, differentiation, lymph-vascular invasion, and lymph node status.
- Classification of cases into Pattern A (well-demarcated glands), Pattern B (early destructive stromal invasion), and Pattern C (diffuse destructive invasion).
Main Results:
- Pattern A tumors (20.7% of cases) showed no lymph node metastases or recurrences.
- Pattern B tumors (25.6% of cases) had a low rate of positive nodes (4.4%).
- Pattern C tumors (53.7% of cases) had a higher rate of metastatic nodes (23.8%).
Conclusions:
- The proposed pattern-based classification system is simple, applicable, and clinically significant for managing endocervical adenocarcinoma.
- Pattern A classification identifies a group of patients who can be spared lymphadenectomy, reducing morbidity.
- This system aids in tailoring treatment strategies, with aggressive approaches indicated for Pattern C tumors.
