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

Czech version

Authors: Borek Sehnal ¹; Iva Kinkorová Luňáčková ²; Michal Zikán ¹; Emanuela Kmoníčková ³; Jiří Sláma ⁴
Authors‘ workplace: 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: Čes.-slov. Patol., 56, 2020, No. 1, p. 38-44
Category: Reviews Article

Overview

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

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