Real-world utility of Silva pattern in predicting outcomes in cervical adenocarcinoma from a population-based series

Silva pattern in cervical adenocarcinoma (AC) is associated with lymph node (LN) involvement. Utility of Silva pattern from diagnostic specimen is uncertain. Our aim was to determine concordance and outcomes for prospectively classified Silva pattern.

This was a single-centre retrospective study of patients with AC and assigned Silva pattern from 2018 to 2024. The primary outcome was concordance between diagnostic and surgical Silva patterns in cases treated surgically, and false negative (FN) rate of diagnostic Silva A where cases were upgraded to Silva B or C on final pathology. Secondary outcomes were LN involvement, stage, and recurrence for each pattern assessed using Fisher's Exact test.

Of 107 patients, final Silva A, B, and C patterns were identified in 28 (26.2 %), 34 (31.8 %), and 45 (42.1 %), respectively. Among surgical cases, there was significant discrepancy between diagnostic and surgical Silva pattern (p = 0.004). FN rate of diagnostic Silva A was 17.6 %. LN were positive in 0, 1 (3.3 %), and 7 (15.6 %) with patterns A, B, and C (p = 0.032). There were 7 recurrences, including 3 with Silva B and 4 with Silva C (p = 0.032). Stage was significantly different with 0, 4 (11.8 %) and 17 (37.8 %) of Silva A, B, and C patients presenting with stage IB3-IV disease (p < 0.001).

Discrepancy exists between diagnostic and surgical Silva patterns. Caution is advised in using diagnostic Silva pattern to guide treatment, particularly deescalating treatment in case of Silva A. Those with Silva C had significantly higher rates of advance stage, nodal involvement, and recurrences compared to Silva A and B.