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S3-Leitlinie Diagnostik und Therapie des Zervixkarzinoms

Anforderungen an die Pathologie

S3 guidelines on diagnostics and treatment of cervical cancer

Demands on pathology

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Zusammenfassung

Zwischen 2011 und Ende 2014 wurde die bis dahin gültige S2k-Leitlinie für die Diagnostik und Therapie des Zervixkarzinoms aktualisiert und auf S3-Niveau angehoben. Die vorliegende Übersicht fasst die relevanten Aspekte des Zuschnitts, der histopathologischen Diagnostik und der Befundabfassung für die Pathologie des invasiven Zervixkarzinoms zusammen. Die Empfehlungen umfassen kolposkopisch gezielt entnommene Biopsien, Konisationen, Trachelektomien und die Präparate nach radikaler Hysterektomie sowie Lymphonodektomien einschließlich der Sentinellymphknotendiagnostik. Die Leitlinie berücksichtigt neben praktischen Aspekten der Pathologie ebenso die klinischen Notwendigkeiten an die Histopathologie für eine optimale operative, strahlentherapeutische und adjuvante Therapie der Patientinnen. Erstmals wurde die tiefe Stromainvasion beim makroinvasiven Zervixkarzinom definiert als eine Tumorinfiltration in das zervikale Stroma von > 66 %. Zusätzlich werden morphologische Prognosefaktoren des mikro- und makroinvasiven Zervixkarzinoms zusammengefasst.

Abstract

Between 2011 and the end of 2014 the former consensus S2k guidelines for the diagnostics and treatment of cervical cancer were updated and upgraded to S3 level, methodologically based on the regulations of the German Cancer Society (DKG). The present article summarizes the relevant aspects for the sectioning, histopathological workup, diagnostics and reporting for the pathology of invasive cancer of the uterine cervix. The recommendations are based on the most recent World Health Organization (WHO) and TNM classification systems and consider the needs of the clinician for appropriate surgical and radiotherapeutic treatment of patients. Detailed processing rules of colposcopy-guided diagnostic biopsies, conization and trachelectomy as well as for radical hysterectomy specimens and lymph node resection (including sentinel lymph node resection) are given. In the guidelines deep stromal invasion in macroinvasive cervical cancer is defined for the first time as tumor infiltration of > 66 % of the cervical stromal wall. Furthermore, morphological prognostic factors for microinvasive and macroinvasive cervical cancer are summarized.

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Authors and Affiliations

  1. Institut für Pathologie ad interim, Abteilung Mamma-, Gynäko- & Perinatalpathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 24, 04103, Leipzig, Deutschland

    L.-C. Horn

  2. Universitätsfrauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    M.W. Beckmann & M.C. Koch

  3. Deutsche Krebsgesellschaft, Berlin, Deutschland

    M. Follmann

  4. Klinik und Poliklinik für Gynäkologie und Geburtshilfe, Universität Köln, Köln, Deutschland

    P. Mallmann

  5. Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Berlin, Deutschland

    S. Marnitz

  6. Institut für Pathologie, synlab MVZ Pathologie Mannheim, Mannheim, Deutschland

    D. Schmidt

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  1. L.-C. Horn
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L.-C. Horn, M.W. Beckmann, M. Follmann, M.C. Koch, P. Mallmann, S. Marnitz und D. Schmidt geben an, dass kein Interessenkonflikt besteht.

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H. Baba, Essen

L.-C. Horn, M. W. Beckmann, M. Follmann, M. C. Koch, P. Mallmann, S. Marnitz, D. Schmidt sind Mitglieder der Kommission zur Erstellung der S3-Leitlinie Zervixkarzinom.

Die Abbildungen 2 bis 4 sind nicht Gegenstand der Leitlinie und nicht in dieser enthalten. Sie sind auf Wunsch des Verlags/Gutachters in das Manuskript zum besseren Verständnis aufgenommen worden.

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Horn, LC., Beckmann, M., Follmann, M. et al. S3-Leitlinie Diagnostik und Therapie des Zervixkarzinoms. Pathologe 36, 585–593 (2015). https://doi.org/10.1007/s00292-015-0114-z

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