Lacunae in International Federation of Gynecology and Obstetrics (FIGO) Classification for Cervical Carcinoma

Abstract

International Federation of Gynecology and Obstetrics (FIGO) staging for cervical cancer does not yet consider findings of cross-sectional imaging unlike clinical tumor, node, and metastasis (TNM) staging system. We compare the two with regard to accuracy in pretreatment staging and their reliability in the prediction of prognosis. This was an observational study of patients with biopsy-proven nonmetastatic cervical carcinoma. Pretreatment evaluation of patients was done by clinical assessment and contrast-enhanced computed tomographic scan of the pelvis to stage the disease with FIGO and clinical TNM (cTNM) system, respectively. The extent of discordance between the 2 staging systems were studied in assessing stage of disease, correlation with histopathologic classification in patients who were operated on, and in prediction of prognosis. The study included 54 patients. Seventeen of 19 patients with early-stage disease underwent upfront radical surgery; and in 59% of these, FIGO did not match with final histopathologic TNM (pTNM), but only in 23% patients, cTNM did not match with histopathological TNM (P = 0.02). Sensitivity of computed tomographic scan to pick up lymph node metastasis was 85% in early disease. Stage migration rates to higher stage when considering imaging findings in stage I, stage IIA, and stage IIB were 25%, 71%, and 37%, respectively. Thirty-four percent of stage IIIB disease was downstaged with cTNM. Lymph node positivity by cTNM was a strong pointer of recurrence (P = 0.01). Pretreatment cross-sectional imaging may help avoid undue surgery in patients with cervical cancer with positive lymph nodes and may help in a more accurate assessment of prognosis.