Rj. Stock et al., EVALUATION AND COMPARISON OF HISTOPATHOLOGIC GRADING SYSTEMS OF EPITHELIAL CARCINOMA OF THE UTERINE CERVIX - GYNECOLOGIC-ONCOLOGY-GROUP STUDIES, International journal of gynecological pathology, 13(2), 1994, pp. 99-108
The subjects of this study are 445 patients with advanced cervical can
cer treated by standardized radiation therapy. Upon entry into one of
two Gynecologic Oncology Group (GOG) protocols, original pathologic di
agnoses and histologic tumor descriptions for each patient were compar
ed with separate evaluations made by a consensus opinion of two GOG pa
thologists. A review diagnosis using grade, cell type, and the Stendah
l scoring system was then made by the first author (R.J.S.) without kn
owledge of the prior diagnoses. Of the original pathologists' diagnose
s, 21% did not include grade or cell type. There was little agreement
among the different pathologists as to the use of either specific grad
e or cell type. Histologic grade, ir-respective of the pathologists ma
king the diagnosis, had no correlation to prognosis. The Reagan and We
ntz large-cell keratinizing (LCK) cell type, when applied by the autho
r to tumors with any form of squamous keratinization present, identifi
ed a group of patients with a poorer prognosis, although not independe
ntly of other prognostic factors. The Stendahl scoring system identifi
ed a number of patients with both a poorer and better prognosis. This
was statistically significant and independent of other risk factors. A
major limitation, however, was the number of patients evaluable becau
se of inadequate biopsy material in 23.6% of the study group.