Jung Mi Byun1,2, Hwa Jin Cho3, Ha Young Park4, Young Nam Kim1,2, Kyung Bok Lee1,2, Moon Su Sung1,2, Chul Hoi Jeong5, Dae Hoon Jeong6,7. 1. Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 47392, Busan, Republic of Korea. 2. Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea. 3. Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 47392, Busan, Republic of Korea. eunhasu101@hanmail.net. 4. Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 47392, Busan, Republic of Korea. 5. Department of Obstetrics and Gynecology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea. 6. Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, 47392, Busan, Republic of Korea. obgynjeong@hanmail.net. 7. Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea. obgynjeong@hanmail.net.
Abstract
BACKGROUND: The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. METHODS: We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on "pattern of invasion" as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. RESULTS: A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. CONCLUSION: Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.
BACKGROUND: The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC. METHODS: We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on "pattern of invasion" as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification. RESULTS: A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors. CONCLUSION: Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.
Authors: Kay J Park; Isabel A Cabrero; Oluwole Fadare; Lynn Hoang; Takako Kiyokawa; Esther Oliva; Carlos Parra-Herran; Joseph T Rabban; Andres Roma; Naveena Singh; Robert Soslow; Simona Stolnicu; Jutta Huvila; Samuel Leung; C Blake Gilks Journal: Int J Gynecol Pathol Date: 2021-03-01 Impact factor: 3.326