EVALUATION AND COMPARISON OF HISTOPATHOLOGIC GRADING SYSTEMS OF EPITHELIAL CARCINOMA OF THE UTERINE CERVIX - GYNECOLOGIC-ONCOLOGY-GROUP STUDIES

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.