The Prognostic Value of the Histological Malignancy Index and the Clinical Grouping of Carcinomata of the Uterine Cervix

Abstract

IN 1926 the preliminary results of a study on the significance of the “Histological Malignancy Index” for the prognosis and treatment of carcinomata of the uterine cervix were published by us (1, 2). The histopathology of 139 cases of cervical carcinomata was studied, observing and evaluating nine factors, namely: the special cell type; the irregularity in the size and shape of the cell and nucleus; the distinctness in the outline of the cell; the functional activity of the cell; the hyperchromatism of the nucleus; the number of mitoses and prophases. The details of the determination of the numerical values were also given in the report. Of the 139 cases the end-results were known in 58 cases. The latter were used to establish the relation of the histological malignancy index to the prognosis and treatment. The malignancy index values ranged from 10 to 40 and were arranged in four groups from 10 to 20, 21 to 25, 26 to 30, and 31 to 40. The percentages of good end-results for these histological malignancy index groups were 61.54, 42.85, 27.27, and 0, respectively. Carcinomata with a histological malignancy index of 31 or higher usually have a bad prognosis. The carcinomata were also graded according to the extent of the growth, as determined by physical examinations, and assigned to one of four groups. A survey of the cases treated up to five years ago was made at the same time. The number of carcinomata was 183 and the percentages of five-year good end-results in the clinical groups was 80.0, 33.33, 11.8, and 0, respectively. Carcinomata characterized by fixation of the growth were assigned to clinical Group 4 and invariably gave a poor prognosis. The conclusion drawn from these observations was that a cancer with a histological malignancy index higher than 30 and belonging to the histological malignancy Group 4, or a fixed cancer assigned to clinical Group 4, gives a bad or infaust prognosis. The pathological and clinical investigations have been continued—the former comprise at present 227 cases with 100 known end-results, and the latter include 332 cases, of which 58 have passed a five-year period free from subjective and anatomic evidences of the disease. An interesting fact was brought to light in these investigations. The studies on the distribution of the intensities of rays in the water phantom, initiated by Friedrich, the construction of the modern high voltage transformer, and the perfection of the Coolidge tube have led to a progressive change in the technic of radiation therapy. This, in turn, has brought about a marked increase in the good five-year end-results. The results of the investigations on the histological malignancy index, the clinical groups, and the comparison of five-year cures obtained with the modern high voltage X-ray therapy in combination with radium, with those obtained with the former low voltage X-ray therapy are herewith given.