Clinical staging in carcinoma cervix: Does it correlate with pathological staging?

Abstract

16570 Background: Cervical cancer is a clinically staged malignancy according to FIGO Staging System. The 1994 revision of FIGO staging system is the currently internationally accepted staging system. Being a subjective method, with inter observer variations, it has certain limitations. The surgico pathological TNM staging is however a more accurate and objective method of staging. The purpose of the present article is to compare the clinical FIGO stage with post operative TNM stage in sixty two cases of carcinoma cervix treated with surgery. Materials and Methods: Sixty two patients of early cervical carcinoma were treated with surgery from Jan. 2002 to Dec. 2007 in the department of surgical oncology at Mahavir Cancer Sansthan. A retrospective analysis of these cases was performed. All the patients underwent a thorough clinical evaluation and were staged as per FIGO staging system pre operatively. A punch biopsy was taken from the growth. An ultrasound of the whole abdomen was done in all the cases. After appropriate pre operative work up all the patients underwent type III radical hysterectomy with bilateral pelvic lymph node dissection. Para aortic lymph node sampling was done in 27 cases. The clinical stage was then compared with the pathological TNM stage post operatively. A comparison was also made between the ultrasonography findings and histopathology. The pre operative histology from punch biopsy was compared to the final histology. 28 patients (45%) received adjuvant radiation therapy. All the patients were followed up regularly as per guidelines with a median follow up of 12 months (Range 3–42m). Results: On comparison of FIGO & TNM Stage, there was a discrepancy between the two in 18 patients (29%). 10 (16%) patients got upstaged whereas in 8 (13%) patients the disease was down staged. In 3 patients the disease got up staged because of metastasis in pelvic lymph node. 5 patients got up staged due to microscopic vaginal involvement. Tumor size led to upstaging in 2 patients. All upstaged patients required Adjuvant Radiotherapy. Conclusion: Clinical staging being observer dependent is not an objective method of staging and significant discrepancies have been observed between the two staging systems. No significant financial relationships to disclose.