Endocervical involvement in endometrial adenocarcinoma is not prognostically significant and the pathologic assessment of the pattern of involvement is not reproducible.

TitleEndocervical involvement in endometrial adenocarcinoma is not prognostically significant and the pathologic assessment of the pattern of involvement is not reproducible.
Publication TypeJournal Article
Year of Publication2013
AuthorsZaino RJ, Abendroth C, Yemelyanova A, Oliva E, Lim D, Soslow R, DeLair D, Hagemann IS, Montone K, Zhu J
JournalGynecol Oncol
Volume128
Issue1
Pagination83-87
Date Published2013 Jan
ISSN1095-6859
KeywordsAdenocarcinoma, Adult, Aged, Cervix Uteri, Endometrial Neoplasms, Female, Humans, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Prognosis, Reproducibility of Results
Abstract

OBJECTIVES: Since 1988, cervical gland involvement and stromal invasion defined stage IIA and stage IIB endometrial carcinoma. In 2009, FIGO changed the criteria for stage II disease to include only those with cervical stromal invasion. We wished to: 1) assess the reproducibility of pathologists to distinguish patterns of cervical spread, and 2) determine the prognostic significance of cervical involvement.

METHODS: Slides from 46 women with cervical involvement by endometrial adenocarcinoma were scored for 5 patterns of involvement by 6 experienced pathologists to determine reproducibility. To assess prognostic significance, 206 patients with FIGO 1988 stage II adenocarcinoma formed the study population with matched FIGO stage I controls.

RESULTS: At least 5 of the 6 pathologists agreed that the cervix was involved in the 46 cases. The reproducibility for cervical gland involvement and endocervical stromal invasion was slight (kappas of 0.15 and 0.28). The survival with any type of cervical involvement was not significantly different from that of matched stage I controls (p=0.18). The 5year recurrence-free survival rates were 84% for FIGO 1988 stage I, 73% for stage IIA, and 82% for stage IIB (FIGO 2009 stage II).

CONCLUSIONS: Pathologists reliably recognize cervical involvement by endometrial carcinoma. However, reproducibility for the determination of pattern of cervical spread by experienced pathologists is too low to be of clinical utility. Women with spread of carcinoma to the cervix do not have a significantly lower survival than matched stage I controls. Cervical spread should not be the basis for determination of stage II disease.

DOI10.1016/j.ygyno.2012.09.035
Alternate JournalGynecol Oncol
PubMed ID23063759
Grant ListP50 CA098252 / CA / NCI NIH HHS / United States
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