Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis
Objective: We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death. Method: We systematically searched PubMed, Scopus, and Embase through 2...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-06-01
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| Series: | Gynecologic Oncology Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S235257892500089X |
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| author | Nikita Sinha Olivia D. Lara Kimberly Dessources Emily P. Jones Leslie H Clark Russell Broaddus Benjamin B. Albright |
| author_facet | Nikita Sinha Olivia D. Lara Kimberly Dessources Emily P. Jones Leslie H Clark Russell Broaddus Benjamin B. Albright |
| author_sort | Nikita Sinha |
| collection | DOAJ |
| description | Objective: We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death. Method: We systematically searched PubMed, Scopus, and Embase through 2024 for manuscripts describing patients with EAC by Silva pattern-based classification. We included studies reporting outcomes of LN metastasis, recurrence, or death by Silva pattern. Random-effects meta-analysis was used to summarize binomial proportions and compare outcomes between groups. Results: We identified 19 studies including 2998 patients (20.8 % pattern A, 23.1 % pattern B, 54.1 % pattern C). Silva pattern A cases showed a significantly lower risk of LN metastasis (3/509; 0.6 %) than pattern B (6.1 %; OR = 0.33, 95 %CI 0.16–0.67) or pattern C (22.0 %; OR = 0.09; 95 %CI 0.05–0.16). Across 5 studies limited to stage I disease, there were no Silva pattern A cases with LN metastasis, recurrence, or death. Among 11 studies reporting on recurrence and death, Silva pattern A cases had distinctly low risk of 0.3 % for both outcomes, including a significantly lower risk of recurrence (OR = 0.15, 95 %CI 0.06–0.34) and death (OR = 0.21, 95 %CI 0.09–0.50) versus patterns B/C. Silva pattern B cases showed significantly lower risk of all outcomes compared with pattern C. Conclusions: We demonstrate that Silva classification is highly predictive of oncologic outcomes for EAC, with patterns A, B, and C showing distinct low, intermediate, and high risk profiles. The low risk profile of pattern A may justify future prospective study of surgical and adjuvant treatment de-escalation from the current standard of care, while pattern C cases may warrant consideration of adjuvant treatment escalation. |
| format | Article |
| id | doaj-art-9210455485ce4ae3b1c838cdce05ebda |
| institution | Kabale University |
| issn | 2352-5789 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj-art-9210455485ce4ae3b1c838cdce05ebda2025-08-20T03:30:51ZengElsevierGynecologic Oncology Reports2352-57892025-06-015910176410.1016/j.gore.2025.101764Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysisNikita Sinha0Olivia D. Lara1Kimberly Dessources2Emily P. Jones3Leslie H Clark4Russell Broaddus5Benjamin B. Albright6Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Corresponding author at: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 103B Physicians’ Office Building, Campus Box #7572, Chapel Hill, NC 27590, USA.Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USADepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USAHealth Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USADepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USADepartment of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC, USADepartment of Obstetrics and Gynecology, Division of Gynecologic Oncology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USAObjective: We aimed to describe the discriminatory ability of the Silva pattern-based classification system for invasive endocervical adenocarcinoma (EAC) in predicting risks of lymph node (LN) metastasis, recurrence, and death. Method: We systematically searched PubMed, Scopus, and Embase through 2024 for manuscripts describing patients with EAC by Silva pattern-based classification. We included studies reporting outcomes of LN metastasis, recurrence, or death by Silva pattern. Random-effects meta-analysis was used to summarize binomial proportions and compare outcomes between groups. Results: We identified 19 studies including 2998 patients (20.8 % pattern A, 23.1 % pattern B, 54.1 % pattern C). Silva pattern A cases showed a significantly lower risk of LN metastasis (3/509; 0.6 %) than pattern B (6.1 %; OR = 0.33, 95 %CI 0.16–0.67) or pattern C (22.0 %; OR = 0.09; 95 %CI 0.05–0.16). Across 5 studies limited to stage I disease, there were no Silva pattern A cases with LN metastasis, recurrence, or death. Among 11 studies reporting on recurrence and death, Silva pattern A cases had distinctly low risk of 0.3 % for both outcomes, including a significantly lower risk of recurrence (OR = 0.15, 95 %CI 0.06–0.34) and death (OR = 0.21, 95 %CI 0.09–0.50) versus patterns B/C. Silva pattern B cases showed significantly lower risk of all outcomes compared with pattern C. Conclusions: We demonstrate that Silva classification is highly predictive of oncologic outcomes for EAC, with patterns A, B, and C showing distinct low, intermediate, and high risk profiles. The low risk profile of pattern A may justify future prospective study of surgical and adjuvant treatment de-escalation from the current standard of care, while pattern C cases may warrant consideration of adjuvant treatment escalation.http://www.sciencedirect.com/science/article/pii/S235257892500089XEndocervical adenocarcinomaPathologySilva pattern of invasionSilva classification systemLymph node metastasis |
| spellingShingle | Nikita Sinha Olivia D. Lara Kimberly Dessources Emily P. Jones Leslie H Clark Russell Broaddus Benjamin B. Albright Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis Gynecologic Oncology Reports Endocervical adenocarcinoma Pathology Silva pattern of invasion Silva classification system Lymph node metastasis |
| title | Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis |
| title_full | Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis |
| title_fullStr | Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis |
| title_full_unstemmed | Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis |
| title_short | Identification of low-risk cases of invasive endocervical adenocarcinoma with Silva pattern-based classification: a systematic review and meta-analysis |
| title_sort | identification of low risk cases of invasive endocervical adenocarcinoma with silva pattern based classification a systematic review and meta analysis |
| topic | Endocervical adenocarcinoma Pathology Silva pattern of invasion Silva classification system Lymph node metastasis |
| url | http://www.sciencedirect.com/science/article/pii/S235257892500089X |
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