Skip to main content
SpringerLink
Log in

Änderungen der TNM-Klassifikation gynäkologischer Tumoren

Changes in the TNM classification of gynecological tumors

  • Schwerpunkt
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Daten sowohl von klinischen als auch pathologischen Studien der letzten Jahre haben eine Überarbeitung der TNM-Klassifikation gynäkologischer Tumoren notwendig gemacht. Die grundlegendste Überarbeitung erfolgte beim Vulvakarzinom. Hier wurde die alleinige Bedeutung der Tumorgröße durch andere Parameter ergänzt. Die Zahl metastatisch befallener regionärer Lymphknoten hat Eingang in das Staging gefunden. Beim Zervixkarzinom wird die Kategorie T2a anhand der Tumorgröße mit einem Grenzwert von ≤4 cm vs. >4 cm unterteilt in T2a1 und T2a2. Beim Endometriumkarzinom erfolgte die Neuordnung der Kategorie T1 (Tumoren auf das Corpus uteri beschränkt) sowie eine neue Definition der Kategorie T2. Für Uterussarkome (Leiomyosarkome, endometriale Stromasarkome/Adenosarkome) wurde erstmals eine TNM-Klassifikation eingeführt.

Abstract

Based on the results of clinical and histomorphological studies in recent years, a revision of the TNM classification of malignant tumours of the female genital organs became necessary. Vulvar cancer saw the most significant changes. In the T1 category the new system recognises tumour size and its relation to the infiltration of adjacent structures by the tumour. The number of positive regional lymph nodes has also been included in the new staging system. For cervical cancer, there is a new subdivision of the category T2a depending on tumour size with a breakpoint of ≤4 cm versus >4 cm and a subdivision into T2a1 und T2a2. In endometrial cancer, the previous pT1a and pT1b were merged to pT1a. The former category T1c has changed into T1b. The category pT1c is no longer used. For the first time, there is a TNM classification system for uterine sarcomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abeler VM, Røyne O, Thoresen S et al (2009) Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology 3:3553–3564

    Google Scholar 

  2. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) (2008) Leitlinien zum Zervixkarzinom, zum Endometriumkarzinom und zu den Trophoblasttumoren. Zuckschwerdt, München Wien New York

  3. Beller U, Quinn MA, Benedet JL et al (2006) Carcinoma of the vulva. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95 (Suppl 1):S7–S27

    Article  PubMed  Google Scholar 

  4. Boronow RC, Morrow CP, Creasman WT et al (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63:825–832

    CAS  PubMed  Google Scholar 

  5. Castro CY, Deavers M (2001) Ductal carcinoma in-situ arising in mammary-like glands of the vulva. Int J Gynecol Pathol 203:277–283

    Article  Google Scholar 

  6. Chan JK, Sugiyama V, Pham H et al (2007) Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis. Gynecol Oncol 104:636–641

    Article  PubMed  Google Scholar 

  7. Creasman WT, Disaia PJ, Blessing J et al (1981) Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals. Am J Obstet Gynecol 141:921–929

    CAS  PubMed  Google Scholar 

  8. Creasman WT, Morrow CP, Bundy BN et al (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group study. Cancer 60 (Suppl):2035–2041

    Article  CAS  PubMed  Google Scholar 

  9. Creasman WT, Odicino F, Maisonneuve P et al (2003) Carcinoma of the corpus uteri. Int J Gynaecol Obstet 83 (Suppl 1):79–118

    Article  PubMed  Google Scholar 

  10. Creasman WT, Odicino F, Maisonneuve P et al (2006) Carcinoma of the corpus uteri. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95 (Suppl 1):S105–S143

    Article  PubMed  Google Scholar 

  11. D’Angelo E, Prat J (2010) Uterine sarcomas: a review. Gynecol Oncol 116:131–139

    Article  Google Scholar 

  12. Delgado G, Bundy B, Zaino R et al (1990) Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 38:352–357

    Article  CAS  PubMed  Google Scholar 

  13. AJCC (American Joint Committee on Cancer) (2010) Cancer staging manual. Edge SB, Byrd DR, Compton CC et al (Hrsg) 7. Aufl. Springer, New York, S 377–444

  14. Fanning J, Alvarez PM, Tsukada Y, Piver MS (1991) Prognostic significance of the extent of cervical involvement by endometrial cancer. Gynecol Oncol 40:46–77

    Article  CAS  PubMed  Google Scholar 

  15. FIGO (International Federation of Gynecology and Obstetrics) (1989) FIGO announcements, stages 1988 revision. Gynecol Oncol 35:125

    Article  Google Scholar 

  16. FIGO (International Federation of Gynecology and Obstetrics) Committee on Gynecologic Oncology (2009) FIGO staging for uterine sarcomas. Int J Gynaecol Obstet 104:179

    Article  Google Scholar 

  17. Grimshaw RN, Tupper WC, Fraser RC et al (1990) Prognostic value of peritoneal cytology in endometrial carcinoma. Gynecol Oncol 36:97–100

    Article  CAS  PubMed  Google Scholar 

  18. Hacker NF, Berek JS, Lagasse LD et al (1983) Management of regional lymph nodes and their prognostic influence in vulvar cancer. Obstet Gynecol 4:408–412

    Google Scholar 

  19. Hacker NF (2009) Revised FIGO staging for carcinoma of the vulva. Int J Gynaecol Obstet 105:105–106

    Article  PubMed  Google Scholar 

  20. Hantschmann P (Hrsg) (2009) Interdisziplinäre S2-Leitlinie der Präneoplasien und Karzinome der Vulva. Zuckschwerdt, Wien

  21. Hart WR (2001) Vulvar intraepithelial neoplasia: historical aspects and current status. Int J Gynecol Pathol 1:16–30

    Article  Google Scholar 

  22. Heller DS (2007) Report of a new ISSVD classification of VIN. J Low Genit Tract Dis 11:46–47

    PubMed  Google Scholar 

  23. Homesley HD, Bundy BN, Sedlis A et al (1991) Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study). Am J Obstet Gynecol 164:997–1004

    CAS  PubMed  Google Scholar 

  24. Horn LC, Dallacker M, Bilek K (2009) Karzinosarkome (Maligne Müllersche Mischtumoren) des Uterus: Morphologie, molekulare Pathogenese und morphologische Prognosefaktoren. Pathologe 30:292–301

    Article  PubMed  Google Scholar 

  25. Horn LC, Fischer U, Raptis G et al (2007) Tumor size is of prognostic value in surgically treated FIGO stage II cervical cancer. Gynecol Oncol 107:310–315

    Article  PubMed  Google Scholar 

  26. Horn LC, Schierle K (2009) Pathologie der Präkanzerosen und der Karzinome von Vulva und Vagina sowie morphologische Prognosefaktoren. Onkologe 15:15–27

    Article  Google Scholar 

  27. Horn LC, Schmidt D, Fathke C, Ulrich U (2009) Mitglieder der Organgruppe Uterus der AGO. Neues FIGO-Staging System für uterine Sarkome. Pathologe 30:302–303

    Article  PubMed  Google Scholar 

  28. Horn LC, Trost M, Bilek K (2010) Staging of endometrial carcinoma – aspects of ovarian and cervical involvement. Int J Gynecol Pathol 29:63–66

    Article  PubMed  Google Scholar 

  29. Kasamatsu T, Onda T, Katsumata N et al (2003) Prognostic significance of positive peritoneal cytology in endometrial carcinoma confined to the uterus. Br J Cancer 88:245–250

    Article  CAS  PubMed  Google Scholar 

  30. Kennedy AW, Webster KD, Nunez C, Bauer LJ (1993) Pelvic washings for cytologic analysis in endometrial adenocarcinoma. J Reprod Med 38:637–642

    CAS  PubMed  Google Scholar 

  31. Lataifeh I, Nascimento MC, Nicklin JL et al (2004) Patterns of recurrence and disease-free survival in advanced squamous cell carcinoma of the vulva. Gynecol Oncol 95:701–705

    Article  PubMed  Google Scholar 

  32. Lee CM, Slomovitz BM, Greer M et al (2005) Practice patterns of SGO members for stage IIIA endometrial cancer. Gynecol Oncol 98:77–83

    Article  PubMed  Google Scholar 

  33. McCluggage WG (2002) Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas? J Clin Pathol 55:321–325

    CAS  PubMed  Google Scholar 

  34. Moinfar F, Azodi M, Tavassoli FA (2007) Uterine sarcomas. Pathology 39:55–71

    Article  PubMed  Google Scholar 

  35. Obermair A, Geramou M, Tripcony L et al (2001) Peritoneal cytology: impact on disease-free survival in clinical stage I endometrioid adenocarcinoma of the uterus. Cancer Lett 164:105–110

    Article  CAS  PubMed  Google Scholar 

  36. Oonk MH, Hollema H, Hullu JA de, Zee AG van der (2006) Prediction of lymph node metastases in vulvar cancer: a review. Int J Gynecol Cancer 16:963–971

    Article  CAS  PubMed  Google Scholar 

  37. Origoni M, Sideri M, Garsia S et al (1992) Prognostic value of pathological patterns of lymph node positivity in squamous cell carcinoma of the vulva stage III and IVA FIGO. Gynecol Oncol 45:313–316

    Article  CAS  PubMed  Google Scholar 

  38. Paladini D, Cross P, Lopes A, Monaghan JM (1994) Prognostic significance of lymph node variables in squamous cell carcinoma of the vulva. Cancer 74:2491–2496

    Article  CAS  PubMed  Google Scholar 

  39. Pecorelli S (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105:103–104

    Article  PubMed  Google Scholar 

  40. Perez CA, Grigsby PW, Chao KS et al (1998) Tumor size, irradiation dose, and long-term outcome of carcinoma of uterine cervix. Int J Radiat Oncol Biol Phys 41:307–317

    CAS  PubMed  Google Scholar 

  41. Petru E, Lück HJ, Stuart G et al Gynecologic Cancer Intergroup (GCIG) (2009) Gynecologic Cancer Intergroup (GCIG) proposals for changes of the current FIGO staging system. Eur J Obstet Gynecol Reprod Biol 143:69–74

    Article  PubMed  Google Scholar 

  42. Piver MS, Chung WS (1975) Prognostic significance of cervical lesion size and pelvic node metastases in cervical carcinoma. Obstet Gynecol 46:507–510

    CAS  PubMed  Google Scholar 

  43. Quinn MA, Benedet JL, Odicino F et al (2006) Carcinoma of the cervix uteri. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95 (Suppl 1):S43–S103

    Article  PubMed  Google Scholar 

  44. Scurry J, Wilkinson EJ (2006) Review of terminology of precursors of vulvar squamous cell carcinoma. J Low Genit Tract Dis 10:161–169

    Article  PubMed  Google Scholar 

  45. Shah SS, Adelson M, Mazur MT (2008) Adenocarcinoma in situ arising in vulvar papillary hidradenoma: report of 2 cases. Int J Gynecol Pathol 27:453–456

    Article  PubMed  Google Scholar 

  46. Sideri M, Jones RW, Wilkinson EJ et al (2005) Squamous vulvar intraepithelial neoplasia: 2004 modified terminology, ISSVD vulvar oncology subcommittee. J Reprod Med 50:807–810

    PubMed  Google Scholar 

  47. Silverberg SG, Kurman RJ, Nogales F et al (2007) Tumors of the uterine corpus. In: Tavassoli FA, Devilee P (Hrsg) Pathology and genetics of tumours of the breast and female genital organs. World Health Organization Classification of Tumours. IARC, Lyon, S 217–232

  48. Sutton GP (1989) Peritoneal cytology in endometrial carcinoma. Cancer Treat Res 49:41–52

    CAS  PubMed  Google Scholar 

  49. Tantipalakorn C, Robertson G, Marsden DE et al (2009) Outcome and patterns of recurrence for International Federation of Gynecology and Obstetrics (FIGO) stages I and II squamous cell vulvar cancer. Obstet Gynecol 113:895–901

    PubMed  Google Scholar 

  50. Tebeu PM, Popowski Y, Verkooijen HM et al (2004) Positive peritoneal cytology in early-stage endometrial cancer does not influence prognosis. Br J Cancer 91:720–724

    PubMed  Google Scholar 

  51. Turner DA, Gershenson DM, Atkinson N et al (1989) The prognostic significance of peritoneal cytology for stage I endometrial cancer. Obstet Gynecol 74:775–780

    CAS  PubMed  Google Scholar 

  52. UICC (Union International Contre l Cancer) (2002) TNM classification of malignant tumours. In: Sobin LH, Wittekind C (Hrsg) 6. Aufl. John Wiley & Sons, New York (deutsche Übersetzung: TNM Klassifikation maligner Tumoren. Wittekind C, Meyer HJ, Bootz F (Hrsg) 6. Aufl. Springer, Berlin Heidelberg New York)

  53. UICC (Union International Contre l Cancer) (2003) TNM Supplement. A commentary on uniform use. In: Wittekind C, Greene FL, Henson DE et al (Hrsg) 3. Aufl. John Wiley & Sons, New York

  54. UICC (Union International Contre l Cancer) (2010) TNM Classification ofMalignant Tumours. Sobin LH, Gospodarowicz MK, Wittekind C (Hrsg) 7. Aufl. Wiley-Blackwell, Oxford (deutsche Übersetzung: TNM-Klassifikation maligner Tumoren, 7. Aufl. Wittekind C, Meyer HJ (Hrsg) Wiley-VCH, Weinheim)

  55. Velden J van der, Schilthuis MS, Hyde SE et al (2004) Squamous cell cancer of the vulva with occult lymph node metastases in the groin: the impact of surgical technique on recurrence pattern and survival. Int J Gynecol Cancer 14:633–638

    Article  PubMed  Google Scholar 

  56. Velden J van der, Lindert AC van, Lammes FB et al (1995) Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival. Cancer 75:2885–2890

    Article  PubMed  Google Scholar 

  57. Wells M, Östör AG, Crum CP et al (2003) Epithelial tumors of the uterine cervix. In: Tavassoli FA, Devilee P (Hrsg) Pathology and genetics of tumours of the breast and female genital organs. World Health Organization Classification of Tumours. IARC, Lyon, S 259–279

  58. Wilkinson EJ, Teixeira MR (2003) Tumors of the vulva. In: Tavassoli FA, Devilee P (Hrsg) Pathology and genetics of tumours of the breast and female genital organs. World Health Organization Classification of Tumours. IARC, Lyon, S 313–334

  59. Yazigi R, Piver MS, Blumenson L (1983) Malignant peritoneal cytology as prognostic indicator in stage I endometrial cancer. Obstet Gynecol 62:359–362

    Article  CAS  PubMed  Google Scholar 

  60. Zaino RJ (2009) FIGO staging of endometrial adenocarcinoma: a critical review and proposal. Int J Gynecol Pathol 28:1–9

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Pathologie, Universitätsklinikum Leipzig, Liebigstr. 26, 04103, Leipzig, Deutschland

    L.-C. Horn, A. Beller & C. Wittekind

  2. Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    M.W. Beckmann

  3. Institut für Pathologie, Allgemeine Histologie und Zytologie, Mannheim, Deutschland

    D. Schmidt

  4. Klinik für Gynäkologie und Geburtshilfe, Martin-Luther-Krankenhaus, Berlin, Deutschland

    U. Ulrich

  5. Abteilung Gynäkologie und Geburtshilfe, Kreiskliniken Altötting-Burghausen, Altötting-Burghausen, Deutschland

    P. Hantschmann

Authors
  1. L.-C. Horn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.W. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Beller
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Ulrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Hantschmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Wittekind
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L.-C. Horn.

Additional information

L.-C. Horn, M.W. Beckmann, D. Schmidt, U. Ulrich: Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Organkommission Uterus.

L.-C. Horn, P. Hantschmann: Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), Organkommission Vulva/Vagina.

M.W. Beckmann, C. Wittekind: Mitglieder im deutschsprachigen TNM-Komitee (DSK-TNM).

M.W. Beckmann: Mitglied im „FIGO-Staging Committee“.

C. Wittekind: Mitglied in der „UICC Prognostic Factors Core Group“.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horn, LC., Beckmann, M., Beller, A. et al. Änderungen der TNM-Klassifikation gynäkologischer Tumoren. Pathologe 31, 367–373 (2010). https://doi.org/10.1007/s00292-010-1308-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-010-1308-z

Schlüsselwörter

Keywords

Search

Navigation