Improved risk prediction in HPV-associated endocervical adenocarcinoma through assessment of binary silva pattern-based classification: international multicenter retrospective study of the international society of gynecological pathologists

Aime Powell, Anjelica Hodgson, Paul Cohen, Joseph T. Rabban, Kay J. Park, W. Glenn McCluggage, C. Blake Gilks, Naveena Singh, Esther Oliva

Research output: Contribution to journalAbstract/Meeting Abstractpeer-review


Introduction Endocervical adenocarcinomas (EACs) are neoplasms associated with diverse pathogenesis, morphology, and clinical behavior. The Silva pattern-based classification categorizes HPV-associated EACs based on the morphology of the invasion and predicts lymph node metastasis and recurrence. Traditionally the Silva classification was a three-tier system (pattern A, B, and C). A two-tier/binary system has recently been proposed whereby tumors are classified into low risk (pattern A/pattern B without lymphovascular invasion (LVSI)) and high risk (pattern B with LVSI/pattern C). Our aim was to develop a prognostic model for surgically treated FIGO stage IA2-IB3 EACs that incorporates patient age, LVSI, FIGO stage and three- and two-tier Silva systems.

Methods The International Society of Gynecological Pathologists (ISGyP) established a multicenter consortium to pool de-identified individual patient data for patients with HPV-associated EACs. All participating pathologists completed mandatory online training.

Results Our cohort comprised 792 HPV-associated EACs (table 1). On multivariate analysis a binary Silva system was associated with recurrence-free and disease specific survival (p<0.05) while FIGO 2018 stage I substages were not. In the current three-tiered system, disease specific survival for patients with pattern B tumors did not significantly differ from those with pattern C tumors while those with pattern A tumors did (table 2).

Conclusion/Implications These findings highlight the need for future prospective studies to further investigate the prognostic significance of stage I HPV-associated EAC substaging and the inclusion of the binary Silva pattern of invasion classification, which includes LVSI status, as a component of treatment recommendations.
Original languageEnglish
JournalInternational Journal of Gynecological Cancer
Issue numberSuppl 4
Publication statusPublished - 2023
EventInternational Gynecological Cancer Society Annual Global Meeting - COEX Convention Centre, Seoul, Korea, Democratic People's Republic of
Duration: 5 Nov 20237 Nov 2023

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