Patterns of Invasion of Cervical Adenocarcinoma as Predicators of Outcome

In this review, a recently published pattern-based risk stratification system of endocervical adenocarcinoma (EAC) is presented. This novel system evaluates the morphologic features of the tumor and establishes patterns that are associated with a particular tumor behavior. Patients with pattern A EAC do not develop lymph node metastasis, and therefore avoiding lymph node resection in these patients should be considered. These patients also have stage I tumors and conservative surgery would be beneficial to decrease morbidity. Patients with pattern B tumors rarely show metastases to lymph nodes, only if there is lymphovascular invasion, whereas those with pattern C tumors would require aggressive treatment as most lymph node or distant metastases and recurrences were noted in patients with this tumor pattern. Combining this new risk stratification system with an algorithm that surgeons and oncologists could complement to other actionable data would result in a more conservative treatment plan in patients with a new diagnosis of invasive usual-type EAC, as opposed to the current more radical treatment plan. This risk stratification model significantly improves on conventionally used factors such as histologic type, grade, and stage to help manage patients with EAC and identify those in need for aggressive surgical management versus a more conservative approach.