Histopathologic grading of squamous cell carcinoma of the uterine cervix. An evaluation of 70 stage Ib patients.

Multiple histopathologic parameters were evaluated to determine which were of prognostic value in predicting patient outcome. Seventy patients with clinical stage Ib squamous cell carcinoma constituted the study population. The patients were primarily treated by surgery, with actuarial survival rates of 76%, 68%, and 57% at 5-, 10-, and 15-year intervals. Eight of 57 patients (14%) with lymph node material available for review had pelvic lymph node metastases and a decreased survival rate (P less than 0.001). Thirty-six patients had 5 mm or less depth of tumor invasion in their hysterectomy specimen and a 5-year survival rate of 94%. Thirty patients had greater than 5 mm of invasion in resected uteri and a 5-year survival rate of 58% (P = 0.007). None of the patients with less than 5 mm of invasion died of their disease. Evaluation of nine histologic parameters in the initial biopsy specimens demonstrated that only vascular invasion (lymphatic and/or capillary) predicted a poor outcome (P = 0.046). Cell size, inflammatory response, degree of keratinization, or any of the other histologic parameters tested failed to demonstrate significant prognostic value in this study.