Detection And Pathological Factors Of Cervical Cancer Of Endophytic Growth With 188 Cases

Objective:Cervical cancer has one of the highest incidences in female gynecologic malignancies and is widely considered that it’s caused by the infection of high-risk human papillomavirus (HPV) firstly. The cervical cancer lesions were divided into 4 forms for histologically growth pattern:exophytic, endophytic, ulcerative and cervical canal type. According to other reports, cervical cancer of endophytic growth has its own characteristics of pathological factors. Although some small-sample studies have been performed, no systematic article has been published. The purpose of this study was to analyze detection and pathological factors of cervical cancer of endophytic type.Methods:This was a reviewed study of patients with cervical cancer of endophytic growth (FIGO stage Ⅰ B-Ⅱ A) treated with radical hysterectomy and lymph node dissection. Compared primary symptom, imaging examinations, thinprep cytologic test (TCT), high-risk HPV-DNA, colposcopy biopsy between endophytic and exophytic growth, respectively. The investigated pathological factors were as follows: histopathological pattern, differentiation, lymph-vascular space involvement (LVSI), parametrial involvement, stromal invasion and pelvic lymph node metastasis.Results:There were 188cases of endophytic type cervical cancer with stage Ⅰ B-ⅡA (stage Ⅰ B1 in 111 patients, stage I B2 in 39, stage ⅡA1 in 27, stage ⅡA2 in 11). Another group was composed of 475 cases of exophytic type cervical cancer with stage Ⅰ B-ⅡA (stage Ⅰ B1 in 278, stage I B2 in 113, stage ⅡA1 in 56, stage ⅡA2 in 28).The primary symptoms of cervical cancer are often described as irregular vaginal bleeding and contacting hemorrhages, no statistically difference had been seen between this two growth patterns in each clinical stage. There were 91 patients with endophytic growth who received TCT, and 198 patients with exophytic growth. The percentages of inflammation, atypicai squamous cells of unknown significance (ASCUS), ASC cannot exclude high grade squamous intraepithelial lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), high grade squamous intraepithelial lesion (HSIL) and cancer for endophytic growth were 16.5%,25.3%,15.4%,6.6%, 28.6% and 7.7% for endophytic growth. For exophytic growth, the numbers were 18.7%,23.7%,12.1%,10.1%,26.8%,9.6%, respectively. No difference had been seen between them.We analyzed the positive ratios of high-risk HPV-DNA (including the separate analysis for 16 and 18 type of HPV) for endophytic and exophytic growth. There still was no statistical difference between these two types. Gynecological ultrasound and CT can indicate the signs of cervical neoplasm. There were abnormal cervical enlargements with Gynecological ultrasound in 106 patients (62.0%) for endophytic type and in 243 patients (58.6%) for exophytic type. And the numbers of abnormal cervical enlargement in CT reports were 58 (86.6%) for endophytic type and 165 (91.7%) for exophytic type, respectively. Although no statistical difference of cervical neoplasm had been seen, the differences of sensitivity between gynecological ultrasound and CT were significant (χ2= 13.801, P<0.001). Further subgroup analysis was performed that the differences mostly appeared in stage Ⅰ B1 with 57/98 (58.2%) for gynecological ultrasound and 30/32 (93.8%) for CT (χ2=13.801, P<0.001). Nevertheless, there was no difference in the higher clinical stages. Results of colposcopy biopsy often showed as LSIL, HSIL and cancer.90.7%～90.8% of endophytic and exophytic types were directly reported as cervical cancer. No statistically difference was seen for histopathologic pattern and differentiation between these two types.The status showed that 52/188 patients (27.7%) with cervical cancer of endophytic type had lymphatic metastasis and only 89/475 patients (18.7%) with exophytic type had that, having statistically significant differences (χ2= 6.404, P=0.015). Further subgroup investigations indicated that the differences mostly appeared in stage Ⅰ B1 (χ2= 6.404, P=0.015). However, there was no difference in the higher clinical stages. The ratios of lymphatic metastasis of Obturator lymph nodes, iliac blood vessels lymph nodes and common iliac lymph nodes for endophytic and exophytic growth were 23.0%,9.3%,7.8% and 14.1%,8.5%,3.6%. There were statistical significant differences in the metastasis of obturator lymph nodes and common iliac lymph nodes between these two growth patterns (χ12= 7.379, P1=0.009,χ22= 4.225, P2=0.047). However, there was no statistical difference in the ratios of iliac blood vessels lymphatic nodes. Further subgroup analysis of obturator lymph nodes in each clinical stage showed that the differences obviously appeared in stage Ⅰ B1 (χ2= 5.298, P=0.031). But there was no difference in the higher clinical stages. The frequencies of parametrial involvement for endophytic and exophytic types were 18/188 (9.6%) and 22/453 (4.6%), respectively. Statistically significant differences had been seen (x2=5.805, P=0.028). Deep stromal invasion is defined as the thickness of the residual muscular layer less than one half.82.7% patients with endophytic type had deep stromal invasion and the number was 62.4% for exophytic type. Statistically significant differences had been seen (x 2= 24.894, P<0.001). Further subgroup analysis in each clinical stage showed that the differences obviously appeared in stage I B1 (χ2=21.152, P<0.001). The situation was similar with LVSI. There were statistically significant differences between these two growth types (x 2= 16.621, P<0.001) and the differences obviously appeared in stage I B1 (χ2=9.614, P=0.003). Using logistic regression analysis to LVSI of endophytic type cervical cancer with stage I B, we could know that the positive ratios of LVSI stage I B were related to growth patterns and lymph node metastasis (P1=0.022, OR1=1.735, P2<0.001, OR2=3.147).Conclusions:Final conclusions draw from the results are as following:cervical cancer of endophytic growth tends to have more parametrial involvement, deep stromal invasion, LVSI and lymph node involvement than cervical cancer of exophytic growth, especially in stage I B1. CT may have advantage for ultrasound when detecting for cervical cancer of endophytic growth. The positive ratios of TCT, high-risk HPV-DNA, colposcopy biopsy between endophytic and exophytic patterns were similar.