Comparison Of Two Staging Systems In Determination Of Cervical Carcinoma Staging

Background: Cervical carcinoma, the most common reproductive-tract cancer in women, makes great threat to women's health. Although the mortality has dropped in the past ten years because of the screening among female populations, the question of how to facilitate the diagnosis and treatment of cervical carcinoma needs further study. Accurate stage determination is the key point for the following therapy selection and prognostic evaluation. However, cervical carcinoma is the only gynecological malignant tumor with only clinical staging system available. Till now, the staging standard from FIGO is the only criterion for cervical carcinoma stage determination. Although the FIGO standard is practical and widely accepted as the only standard for cervical carcinoma stage determination, the discrepancies between clinical staging and pathologic findings caused by the clinical evaluation, experience of doctors,.etc. are obvious. Incorrect staging may mislead the therapy. Thus it is suggested to have pathological staging standard for cervical carcinoma as well as clinical staging system. Recently, since the progress of the TNM staging system from UICC, FIGO introduces the pTNM classification as the pathological staging standard for cervical carcinoma in order to give accurate indication of prognosis and aid the clinicians in the planning of treatment after surgery.Objective: To compare the differences between clinical (FIGO 1995) and surgical-pathological staging of cervical carcinoma and demonstrate the limitation of clinical staging. To discuss the feasibility and importance of surgical-pathological staging of cervical carcinoma in clinical practice, and how may it help the therapy of cervical carcinoma.Methods: Clinical and pathological data of 335 patients with cervical carcinoma accepted primary surgical treatment from January 2000 to December 2003 were analyzed retrospectively in our hospital. All the patients are applied for both clinical staging and pTNM staging. The differences of the results were compared and the value of these two staging systems in clinical practice were discussed.Results: The total accordance between clinical and surgical-pathologic staging are 42.1 %, and in stage 0 is 77.8 %, stage I A is 75 %, stage I B is 73.3 %, stage IIA is 20.4% and in stage IIB is 3.7%. For vaginal invasion, the sensitivity, specificity, positive and negative predictive value of the pelvic examination are 53.2%> 77.4%, 27.8% and 91.0% respectively, the accuracy is 74%, For parametrial invasion, the values above are 66.7%> 70.8%, 16.7%, 96.0% respectively, the accuracy is 70.4%. The total metastasis rate of pelvic lymph nodes was 22.4%, 9.1 % with stage 0, none with stage IA,19% with stage IB, 22% with stage II A, 30.8% with stage IIB, 1/1 and 1/1 with stage III A and IIIB respectively. The parametrial invasion, vaginal invasion, and metastasis of lymph nodes show the distinct difference between each stage. (P<0.01)Conclusion: There are obvious discrepancies between clinical staging and pathological staging of cervical carcinoma. The following maybe the reasons account for these: ?For stage 0. I A and II A, any problem with the acquiring of specimens or pathological process would end in inaccuracy of staging.?For stage I B. II and III, limitation of clinical examinationand discrepancies of examiners. (3)It is hard to determine whether there is lymph nodes metastasis before surgery. There is a high percentage of discrepancy in clinical stage IIB, thus the over-staging deprives a great number of patients who actually fill in the indications of surgery their opportunities. The metastasis of pelvic lymph nodes is considered to be one of the most important prognostic factors. Since it has clearly defined the status of pelvic lymph nodes and distant metastasis, the surgical-pathological staging (pTNM) is more accurate than the clinical staging in defining the extent of the disease and predicting prognosis for the patient. The surgical-pathological staging is of great significance in clinical practice to some extent, but further discussion is necessarily required.