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Der Pathologe

, Volume 40, Issue 6, pp 629–635 | Cite as

FIGO-Klassifikation für das Zervixkarzinom 2019 – was ist neu?

  • L.-C. HornEmail author
  • C. E. Brambs
  • S. Opitz
  • U. A. Ulrich
  • A. K. Höhn
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  • 186 Downloads

Zusammenfassung

Zahlreiche therapie- und prognoseorientierte Studien zum Zervixkarzinom haben eine Überarbeitung der FIGO-Klassifikation erforderlich gemacht.

Das mikroinvasive Karzinom wird allein durch die Tiefe der Stromainfiltration definiert, die flächige (horizontale) Ausdehnung ist nunmehr irrelevant.

Makroinvasive Karzinome, die auf die Cervix uteri begrenzt sind, werden anhand der Tumorgröße subkategorisiert in: FIGO IB1/T1b1 – zervikale Stromainvasion >5,0 mm und ≤2 cm maximale Tumorgröße, FIGO IB2/T1b2 – Tumorgröße >2 cm und ≤4 cm, FIGO IB3/T1b3 – Tumorgröße >4 cm. Sowohl die pelvinen als auch die paraaortalen Lymphknoten werden als regionäre Lymphknoten definiert. Der Befall pelviner Lymphknoten wird als FIGO IIIC1/pN1a und eine Metastasierung in paraaortale Lymphknoten mit und ohne Beteiligung pelviner Lymphknoten als FIGO IIIC2/pN1b klassifiziert. Der Nachweis einer Corpusinfiltration und eine adnexale/ovarielle Metastasierung sind nicht stagingrelevant.

Schlüsselwörter

Zervixkarzinom Staging FIGO-Klassifikation TNM-Klassifikation Prognose Tumorgröße 

The 2019 FIGO classification for cervical carcinoma—what’s new?

Abstract

Numerous therapeutic and prognostic studies of cervical carcinoma have necessitated a revision of the FIGO classification.

For microinvasive carcinomas, the horizontal dimension is no longer considered and diagnosis and staging will solely be made by the depth of cervical stromal invasion. Lymphovascular invasion beyond the deepest point of stromal infiltration by tumor cells does not alter the stage.

There will be a new subclassification of macroinvasive carcinoma confined to the uterine cervix, which will be made by largest tumor extension as follows: FIGO IB1/T1b1 – invasive carcinoma >0.5 cm depth of stromal invasion and ≤2 cm in largest dimension, FIGO IBII/T1b2: – invasive carcinoma >2 cm and ≤4 cm, FIGO IBII/T1b3 – invasive carcinoma >4 cm. Pelvic as well as para-aortic lymph nodes will be defined as regional nodes. Pelvic lymph node metastases only will be categorised as FIGO IIIC1/pN1a and para-aortic lymph node involvement with or without concomitant pelvic involvement will be FIGO IIIC2/pN1b. Uterine corpus as well as adnexal involvement are not relevant for staging purpose.

Keywords

Cervix and carcinoma Prognosis Staging FIGO-classification TNM-classification Tumor size 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

L.-C. Horn, C. E. Brambs, S. Opitz, U. A. Ulrich und A. K. Höhn geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Al-Kalbani M, McVeigh G, Nagar H et al (2012) Do FIGO stage IA and small (łeq2 cm) IB1 cervical adenocarcinomas have a good prognosis and warrant less radical surgery? Int J Gynecol Cancer 22(2):291–295Google Scholar
  2. 2.
    Baalbergen A, Molijn AC, Quint WGV et al (2015) Conservative treatment seems the best choice in adenocarcinoma in situ of the cervix uteri. J Low Genit Tract Dis 19(3):239–243Google Scholar
  3. 3.
    Bentivegna E, Gouy S, Maulard A et al (2016) Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol 17(6):e240–e253Google Scholar
  4. 4.
    Bhatla N, Aoki D, Sharma DN et al (2018) Cancer of the cervix uteri. Int J Gynaecol Obstet 143(Suppl 2):22–36Google Scholar
  5. 5.
    Bhatla N, Berek JS, Cuello Fredes M et al (2019) Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet 145(1):129–135Google Scholar
  6. 6.
    Boyle DP, McCluggage WG (2015) Stratified mucin-producing intraepithelial lesion (SMILE): report of a case series with associated pathological findings. Histopathology 66(5):658–663Google Scholar
  7. 7.
    Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424Google Scholar
  8. 8.
    Chen J, Wang R, Zhang B et al (2016) Safety of ovarian preservation in women with stage I and II cervical adenocarcinoma: a retrospective study and meta-analysis. Am J Obstet Gynecol 215(4):460.e1Google Scholar
  9. 9.
    Cohen PA, Jhingran A, Oaknin A et al (2019) Cervical cancer. Lancet 393(10167):169–182Google Scholar
  10. 10.
    Del Carmen MG, Pareja R, Melamed A et al (2018) Isolated para-aortic lymph node metastasis in FIGO stage IA2-IB2 carcinoma of the cervix: revisiting the role of surgical assessment. Gynecol Oncol 150(3):406–411Google Scholar
  11. 11.
    Delgado G, Bundy B, Zaino R et al (1990) Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 38(3):352–357Google Scholar
  12. 12.
    Denny L (2015) Control of cancer of the cervix in low- and middle-income countries. Ann Surg Oncol 22(3):728–733Google Scholar
  13. 13.
    Guani B, Dorez M, Magaud L et al (2019) Impact of micrometastasis or isolated tumor cells on recurrence and survival in patients with early cervical cancer: SENTICOL trial. Int J Gynecol Cancer 29(3):447–452Google Scholar
  14. 14.
    Heller PB, Maletano JH, Bundy BN et al (1990) Clinical-pathologic study of stage IIB, III, and IVA carcinoma of the cervix: extended diagnostic evaluation for paraaortic node metastasis—a Gynecologic Oncology Group study. Gynecol Oncol 38(3):425–430Google Scholar
  15. 15.
    Hirschowitz L, Nucci M, Zaino RJ (2013) Problematic issues in the staging of endometrial, cervical and vulval carcinomas. Histopathology 62(1):176–202PubMedGoogle Scholar
  16. 16.
    Höckel M, Hentschel B, Horn L‑C (2014) Association between developmental steps in the organogenesis of the uterine cervix and locoregional progression of cervical cancer: a prospective clinicopathological analysis. Lancet Oncol 15(4):445–456PubMedGoogle Scholar
  17. 17.
    Höckel M, Wolf B, Schmidt K, Mende M, Aktas B, Kimmig R et al (2019) Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from a single-centre, prospective, observational, cohort study. Lancet Oncol 20(9):1316–1326PubMedGoogle Scholar
  18. 18.
    Horn L‑C, Bilek K, Fischer U et al (2014) A cut-off value of 2 cm in tumor size is of prognostic value in surgically treated FIGO stage IB cervical cancer. Gynecol Oncol 134(1):42–46PubMedGoogle Scholar
  19. 19.
    Horn L‑C, Brambs CE, Opitz S et al (2019) TNM-Klassifikation gynäkologischer Tumoren: Was bleibt über 2017 hinaus zu tun? Pathologe 40(1):73–79PubMedGoogle Scholar
  20. 20.
    Horn LC, Handzel R, Borte G, Siebolts U, Haak A, Brambs CE (2019) Invasive stratified mucin-producing carcinoma (i-SMILE) of the uterine cervix—report of a case series and review of the literature indicating poor prognostic subtype of cervical adenocarcinoma. J Cancer Res Clin Oncol.  https://doi.org/10.1007/s00432-019-02991-3 CrossRefGoogle Scholar
  21. 21.
    Horn L‑C, Schierle K, Schmidt D et al (2011) Aktuelle TNM/FIGO-Stadieneinteilung für das Zervix- und Endometriumkarzinom sowie maligne Müller-Mischtumoren. Fakten und Hintergründe. Pathologe 32(3):239–243Google Scholar
  22. 22.
    Hu J, Jiao X, Yang Z et al (2017) Should ovaries be removed or not in early-stage cervical adenocarcinoma: a multicenter retrospective study of 105 patients. J Obstet Gynaecol 37(8):1065–1069Google Scholar
  23. 23.
    Jiang Y, Chen C, Li L (2017) Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ (ACIS): a systematic review and meta-analysis. PLoS ONE 12(1):e170587PubMedCentralPubMedGoogle Scholar
  24. 24.
    Jolly S, Uppal S, Bhatla N et al (2018) Improving global outcomes in cervical cancer: The time has come for international federation of gynecology and obstetrics staging to formally incorporate advanced imaging. J Glob Oncol 4:1–6Google Scholar
  25. 25.
    Kodama J, Fukushima C, Kusumoto T et al (2013) Stage IB1 cervical cancer patients with an MRI-measured tumor size < or = 2 cm might be candidates for less-radical surgery. Eur J Gynaecol Oncol 34(1):39–41Google Scholar
  26. 26.
    Kodama J, Kusumoto T, Nakamura K et al (2011) Factors associated with parametrial involvement in stage IB1 cervical cancer and identification of patients suitable for less radical surgery. Gynecol Oncol 122(3):491–494Google Scholar
  27. 27.
    Landoni F, Zanagnolo V, Lovato-Diaz L et al (2007) Ovarian metastases in early-stage cervical cancer (IA2-IIA): a multicenter retrospective study of 1965 patients (a Cooperative Task Force study). Int J Gynecol Cancer 17(3):623–628Google Scholar
  28. 28.
    Leitlinienprogramm Onkologie (2014) S3-Leitlinie Diagnostik und Therapie Zervixkarzinom. https://www.awmf.org/uploads/tx_szleitlinien/032-033OLl_S3_Zervixkarzinom_2014-10.pdf. Zugegriffen: 6. Sept. 2019Google Scholar
  29. 29.
    McCluggage WG, Judge MJ, Alvarado-Cabrero I et al (2018) Data set for the reporting of carcinomas of the cervix: recommendations from the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 37(3):205–228Google Scholar
  30. 30.
    Narayan K, Fisher RJ, Bernshaw D et al (2009) Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by positron emission tomography and treated with curative intent. Int J Gynecol Cancer 19(5):912–918Google Scholar
  31. 31.
    Nucci MR, Crum CP (2007) Redefining early cervical neoplasia: recent progress. Adv Anat Pathol 14(1):1–10Google Scholar
  32. 32.
    Park JJ, Sun D, Quade BJ et al (2000) Stratified mucin-producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia? Am J Surg Pathol 24(10):1414–1419Google Scholar
  33. 33.
    Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105(2):103–104Google Scholar
  34. 34.
    Schneider A, Erdemoglu E, Chiantera V et al (2012) Clinical recommendation radical trachelectomy for fertility preservation in patients with early-stage cervical cancer. Int J Gynecol Cancer 22(4):659–666Google Scholar
  35. 35.
    Shimada M, Kigawa J, Nishimura R et al (2006) Ovarian metastasis in carcinoma of the uterine cervix. Gynecol Oncol 101(2):234–237Google Scholar
  36. 36.
    Singh N, Arif S (2004) Histopathologic parameters of prognosis in cervical cancer—a review. Int J Gynecol Cancer 14(5):741–750Google Scholar
  37. 37.
    Singh N, Gilks CB (2017) The changing landscape of gynaecological cancer diagnosis: implications for histopathological practice in the 21st century. Histopathology 70(1):56–69Google Scholar
  38. 38.
    Smits RM, Zusterzeel PLM, Bekkers RLM (2014) Pretreatment retroperitoneal para-aortic lymph node staging in advanced cervical cancer: a review. Int J Gynecol Cancer 24(6):973–983PubMedGoogle Scholar
  39. 39.
    Stoler M, Bergeron C, Colgan TJ, Ferency AS, Herrington CS, Kim KR, Loening T, Schneider A, Sherman ME, Wilbur DC, Wright T (2014) Squamous cell tumors of the uterine cervix and its precursors. In: Kurman RJ, Carcangiou ML, Herrington S, Young RH (Hrsg) WHO classification of tumours of female reproductive organs. IARC Press, Lyon, S 172–182Google Scholar
  40. 40.
    Touhami O, Omar T, Plante M et al (2015) Should ovaries be removed or not in (early-stage) adenocarcinoma of the uterine cervix: a review. Gynecol Oncol 136(2):384–388Google Scholar
  41. 41.
    Vandeperre A, van Limbergen E, Leunen K et al (2015) Para-aortic lymph node metastases in locally advanced cervical cancer: comparison between surgical staging and imaging. Gynecol Oncol 138(2):299–303Google Scholar
  42. 42.
    Wilbur DC, Colgan TJ, Ferenczy AS, Hirschowitz L, Löning T, McCluggage WG, MIkami Y, Park KJ, Ronnett BM, Schneider A, Soslow R, Wells M, Wright T (2014) Glandular tumours and precursors of the uterine cervix. In: Kurman RJ, Carcangiu ML, Herrington CS, Young RH (Hrsg) WHO classification of tumours of female reproductive tract. IARC Press, Lyon, S 183–194Google Scholar
  43. 43.
    Wittekind C (2017) Zervixkarzinom. TNM-Klassifikation maligner Tumoren. Wiley, Weinheim, S 216–221Google Scholar
  44. 44.
    Wagner AE, Pappas L, Ghia AJ et al (2013) Impact of tumor size on survival in cancer of the cervix and validation of stage IIA1 and IIA2 subdivisions. Gynecol Oncol 129(3):517–521Google Scholar
  45. 45.
    Wuntakal R, Papadopoulos AJ, Montalto SA et al (2015) Location of sentinel lymph node in cervical carcinoma and factors associated with unilateral detection. Int J Gynecol Cancer 25(9):1663–1668Google Scholar
  46. 46.
    Zhang Q, Li W, Kanis MJ et al (2017) Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 8(28):46580–46592PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • L.-C. Horn
    • 1
    Email author
  • C. E. Brambs
    • 2
  • S. Opitz
    • 1
  • U. A. Ulrich
    • 3
  • A. K. Höhn
    • 1
  1. 1.Arbeitsgruppe Mamma‑, Gynäko- & Perinatalpathologie, Institut für PathologieUniversitätsklinikum Leipzig AöRLeipzigDeutschland
  2. 2.Frauenklinik des Klinikums rechts der IsarTechnische Universität MünchenMünchenDeutschland
  3. 3.Klinik für Gynäkologie und GeburtshilfeMartin-Luther-KrankenhausBerlinDeutschland

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