International Journal of Clinical Oncology

, Volume 24, Issue 10, pp 1264–1272 | Cite as

Clinical significance of the pattern-based classification in endocervical adenocarcinoma, usual and variants

  • Jung Mi Byun
  • Hwa Jin ChoEmail author
  • Ha Young Park
  • Young Nam Kim
  • Kyung Bok Lee
  • Moon Su Sung
  • Chul Hoi Jeong
  • Dae Hoon JeongEmail author
Original Article



The Silva system is a pattern-based classification system that stratifies endocervical adenocarcinomas (AC) into 3 categories to assess the risk of lymph node (LN) metastasis. This study aimed to evaluate whether this novel risk stratification system is applicable to all endocervical AC, including usual and variant, and to suggest a suitable management plan for cervical AC.


We retrospectively retrieved consecutive pathology cases with a final diagnosis of endocervical AC treated via radical hysterectomy and pelvic lymphadenectomy. Specimens were classified by consensus according to the Silva system based on “pattern of invasion” as A, B, or C, further clinical/pathologic features were assessed according to pattern-based classification.


A total of 76 cases of invasive cervical AC were evaluated. Of these, 63 (82.9%) were categorized as usual-type endocervical AC and 13 (17.1%) as special types. Among those with usual and variants, all patients with pattern A tumor had no LN metastasis and did not develop recurrence. Likewise, multivariate analysis revealed that LN metastasis and pattern C or B tumors are significant independent predictors of disease-free survival (DFS). Although pattern A tumors had no LN metastasis, they also developed complications after surgery, similar to pattern B or C tumors.


Regardless of histologic subtypes, pattern A tumors had no LN metastasis and no recurrence. Thus, the Silva classification system can influence the clinical management of all types of endocervical AC. Conservative management is reasonable in all patients with endocervical AC with pattern A tumors.


Endocervical adenocarcinoma Pattern-based classification Management 



This work was supported by 2017 Inje University Busan Paik Hospital research Grant.

Compliance with ethical standards

Conflict of interest

The authors have declared no conflicts of interest.


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Jung Mi Byun
    • 1
    • 2
  • Hwa Jin Cho
    • 3
    Email author
  • Ha Young Park
    • 3
  • Young Nam Kim
    • 1
    • 2
  • Kyung Bok Lee
    • 1
    • 2
  • Moon Su Sung
    • 1
    • 2
  • Chul Hoi Jeong
    • 4
  • Dae Hoon Jeong
    • 1
    • 2
    Email author
  1. 1.Department of Obstetrics and GynecologyBusan Paik Hospital, Inje University College of MedicineBusanRepublic of Korea
  2. 2.Paik Institute for Clinical Research, Inje University College of MedicineBusanSouth Korea
  3. 3.Department of PathologyBusan Paik Hospital, Inje University College of MedicineBusanRepublic of Korea
  4. 4.Department of Obstetrics and GynecologyHaeundae Paik Hospital, Inje University College of MedicineBusanSouth Korea

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