Session Item

The European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) nominated an international multidisciplinary development group consisting of practicing clinicians who have demonstrated leadership and expertise in cervical cancer to produce evidence-based guidelines regarding all aspects of the management of patients with this disease. The first version was published in 2018. The new version is not only a reviewing and updating the previous version, but also expanding it by adding chapters on rare tumor types, ancillary studies (p16 immunohistochemistry, HPV testing, PD-L1 testing) and palliative care.
Herein, we provide a detailed list of the pathological reporting of cervical carcinoma specimens, focusing on practical aspects of specimen sampling and on the core pathological data which are critical for patient management.
•    Specimens from prior conization and subsequent conization, trachelectomy, or hysterectomy should be correlated for estimation of the tumour . This is of importance because different specimens may have been reported at different institutions. It should also be recognized that simply adding the maximum tumour in separate specimens may significantly overestimate the maximum tumour dimension.Histological tumour type according to the most recent WHO classification (currently 5th edition, 2020, in its updated version).
•    The presence or absence of lymphatic vessel invasion (LVI), which may be confirmed by immunohistochemistry. The quantification of the number of lymph vascular vessels involved by tumour cells is not mandatory but advisable for future prospective studies.
•    The presence or absence of venous invasion (V1) and of perineural invasion (Pn1).
•    Coexisting precursor lesions such as squamous intraepithelial lesion/ cervical intraepithelial neoplasia, adenocarcinoma in situ, stratified mucin-producing intraepithelial lesion and other pathological changes of the cervix.
•    Measurements of tumour distance to all surgical margins (including minimum distance of uninvolved cervical stroma).
•    Margin status (invasive and preinvasive diseases). Specify all the margin(s).
•    Lymph node status including sentinel lymph node status, the total number of nodes found, the number of positive lymph nodes, the of the largest metastatic focus, and the presence of extra-nodal extension. In the 8th UICC TNM edition isolated tumour cells deposits are no greater than 0.2 mm (200µm) and should be reported as pN0 (i+). Micrometastasis (200µm to 2 mm in diameter) are reported as pN1(mi).
•    Pathologically confirmed (if required, including immunohistochemistry/HPV DNA) distant metastases. Provisional pathological staging pretumour board/ multidisciplinary team meeting (UICC TNM 9th edition; American Joint Committee on Cancer, 9th edition).
•    Pathological analysis of sentinel nodes.