The role of a pathologist in surgical staging for carcinoma of the cervix uteri

Česká verzia

Authors: Borek Sehnal ¹; Iva Kinkorová Luňáčková ²; Michal Zikán ¹; Emanuela Kmoníčková ³; Jiří Sláma ⁴
Authors place of work: Onkogynekologické centrum, Gynekologicko-porodnická klinika, Nemocnice Na Bulovce a 1. lékařské fakulty Univerzity Karlovy, Praha ¹; Bioptická laboratoř s. r. o., Plzeň ²; Ústav radiační onkologie, Komplexní onkologické centrum, Nemocnice Na Bulovce, Praha ³; Onkogynekologické centrum, Gynekologicko-porodnická klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy, Praha ⁴
Published in the journal: Čes.-slov. Patol., 56, 2020, No. 1, p. 38-44
Category: Reviews Article

Summary

The incidence of cervical cancer is high in the Czech Republic. Altogether 822 new cases were found in this country during 2016 which means the incidence 15,3 new diseases / 100,000 women. FIGO (Fédération Internationale de Gynécologie et d´Obstétrique) staging of carcinoma for the cervix was changed as follows. Lateral extension measurement is removed in the stage IA, the only criterion is the measured deepest invasion <5.0 mm. Stage IB was divided into three subgroups; IB1 - tumors ≤ 2,0 cm in greatest diameter; IB2 - tumors size ≥ 2,0 až < 4,0 cm; IB3 - tumors ≥ 4 cm. Stage IIIC includes an assessment of pelvic and paraaortic lymph nodes; IIIC1 if only pelvic lymph nodes are involved, IIIC2 if paraaortic nodes are infiltrated.

The role of a patologist in surgical staging of a disease is irreplaceable. Sentinel lymph node (SLN) biopsy has been increasingly used in the management of early-stages cervical cancer instead of systematic pelvic lymph node dissection. New European guidelines recommend performing SLN biopsy as the first step of the surgical staging in all early stages of cervical cancer (except IA1) and submitting the SLN for intraoperative assessment to triage patients towards radical surgery or chemoradiotherapy. SLN biopsy with definitive histological assessment by ultrastaging is considered to be more accurate in the assessment of all pelvic lymph nodes involvement than a complete systematic pelvic lymph node dissection.

This approach in surgical staging and other aspects related to pathologic evaluation of the disease are discussed. The aim of this article is to give a overview of mentioned issues.

Keywords:

FIGO – cervical cancer

Zdroje

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of cancer incidence and mortality for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68, 394–424.
Svod.cz [internetova stranka]. Český národní webový portál epidemiologie nádorů. Systém pro vizualizaci onkologických dat. Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity (IBA MU). Dostupný z: http://www.svod.cz.
Kinkorová Luňáčková I, Májek O. Karcinom děložního hrdla v ČR a možnosti jeho prevence. Česk Patol 2018; 63(4): 164-168.
Sláma J. Současné limity prevence karcinomu děložního hrdla v České republice. Čes Gynek 2017; 82(6): 482-486.
Ramirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018; 379(20): 1895-1904.
Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 2019; 145(1): 129-135.
Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology guidelines for the management of patients with cervical cancer. Virchows Arch 2018; 472(6): 919-936.
Dundr P, Němejcová K. Prekancerózy a karcinomy děložního hrdla. Doporučený postup pro bioptické vyšetření. Společnost českých patologů 2018, 1 - 20. Dostupné z: http://www.patologie.info/standardy/
Querleu D, Cibula D, Abu-Rustum NR. 2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy. Ann Surg Oncol 2017; 24(11): 3406-3412.
Cibula D, McCluggage WG. Sentinel lymph node (SLN) concept in cervical cancer: Current limitations and unanswered questions. Gynecol Oncol 2019; 152(1): 202-207.
Zikán M. Volba vhodné bioptické metody u primárně inoperabilního nebo recidivujícího zhoubného nádoru a metodika bioptického odběru. Čes Gynek 2014; 79(6): 487-90.
Sehnal B, Driák D, Kmoníčková E, et al. Současná klasifikace zhoubných nádorů v onkogynekologii – část I. Čes Gynek 2011; 76 (4): 279-284.
Tsunoda AT, Marnitz S, Soares Nunes J, et al. Incidence of Histologically Proven Pelvic and Para-Aortic Lymph Node Metastases and Rate of Upstaging in Patients with Locally Advanced Cervical Cancer: Results of a Prospective Randomized Trial. Oncology 2017; 92(4): 213-220.
Škapa P, Pluta M. Peroperační biopsie v gynekopatologii. Česk Patol 2018; 54(3): 105-118.
Lecuru FR, McCormack M, Hillemanns P, et al. SENTICOL III: an international validation study of sentinel node biopsy in early cervical cancer. A GINECO, ENGOT, GCIG and multicenter study. Int J Gynecol Cancer 2019; pii: ijgc-2019-000332.
Roy M, Bouchard-Fortier G, Popa I, et al. Value of sentinel node mapping in cancer of the cervix. Gynecol Oncol 2011; 122(2): 269-274.
Slama J, Dundr P, Dusek L, Cibula D. High false negative rate of frozen section examination of sentinel lymph nodes in patients with cervical cancer. Gynecol Oncol 2013; 129(2): 384–388.
Martínez A, Mery E, Filleron T, Boileau L, Ferron G, Querleu D. Accuracy of intraoperative pathological examination of SLN in cervical cancer. Gynecol Oncol 2013; 130(3): 525–529.
Brar H, Hogen L, Covens A. Cost-effectiveness of sentinel node biopsy and pathological ultrastaging in patients with early-stage cervical cancer. Cancer 2017; 123(10): 1751–1759.
Cibula D, Abu-Rustum NR, Dusek L, et al. Bilateral ultrastaging of sentinel lymph node in cervical cancer: lowering the false-negative rate and improving the detection of micrometastasis. Gynecol Oncol 2012; 127(3): 462–466.
Colturato LF, Signorini Filho RC, Fernandes RC, Gebrim LH, Oliani AH. Lymph node micrometastases in initial stage cervical cancer and tumoral recurrence. Int J Gynaecol Obstet 2016;133(1): 69-75.
Fischerová D, Cibula D. Role ultrazvuku ve stagingu zhoubného nádoru děložního hrdla (doporučení Evropské onkologické, radiační, a patologické společnosti). Čes Gynek 2019; 84(1): 40–48.
Baiocchi G, de Brot L, Faloppa CC, et al. Is parametrectomy always necessary in early-stage cervical cancer? Gynecol Oncol 2017; 146(1): 16-19.
Sláma J, Černý A, Dušek L, et al. Results of less radical fertility-sparing procedures with omitted parametrectomy for cervical cancer: 5 years of experience. Gynecol Oncol 2016; 142(3): 401-404.