European guidelines for quality assurance in cervical histopathology

Figures & data

Figure 1. Examples of techniques for sectioning exision biopsies.

Figure 2. Serial sections of a cone biopsy in order to detect microinvasive carcinoma (inset).

Table I. Histological classifications of preinvasive intraepithelial lesions of the uterine cervix.

Dysplasia classification	Cervical intraepithelial neoplasia (CIN and CGIN) classification	Bethesda classification (used for cytology)
Mild dysplasia	CIN 1	LGSIL
Moderate dysplasia	CIN 2	HGSIL
Severe dysplasia	CIN 3	HGSIL
Carcinoma in situ	CIN 3	HGSIL
Endocervical dysplasia	CGIN (low-grade, high grade)	AGC
Adenocarcinoma in situ	CGIN (high-grade)	AIS

Table II. WHO histological classification of malignant tumours of the uterine cervix [15].

Epithelial tumours

Squamous tumours and precursors

Squamous cell carcinoma, not otherwise specified

Keratinising

Non-keratinising

Basaloid

Verrucous

Warty

Papillary

Lymphoepithelioma-like

Squamotransitional

Early invasive (microinvasive) squamous cell carcinoma

Squamous intraepithelial neoplasia

Cervical intraepithelial neoplasia (CIN) 3/Squamous cell carcinoma in situ

Benign squamous cell lesions

Condyloma acuminatum

Squamous papilloma

Fibroepithelial polyp

Glandular tumours and precursors

Adenocarcinoma

Mucinous adenocarcinoma

Endocervical

Intestinal

Signet ring cell

Minimal deviation

Villoglandular

Endometroid adenocarcinoma

Clear cell adenocarcinoma

Serous adenocarcinoma

Mesonephric adenocarcinoma

Early invasive adenocarcinoma

Adenocarcinoma in situ

Glandular dysplasia

Benign glandular lesions

Müllerian papilloma

Endocervical polyp

Other epithelial tumours

Adenosquamous carcinoma

Glassy cell carcinoma variant

Adenoid cystic carcinoma

Adenoid basal carcinoma

Neuroendocrine tumours

Carcinoid

Atypical carcinoid

Small cell carcinoma

Large cell neuroendocrine carcinoma

Undifferentiated carcinoma

Mesenchymal tumours and tumour-like conditions

Leiomyosarcoma

Endometroid stromal sarcoma, low grade

Undifferentiated endocervical sarcoma

Sarcoma botroides

Alveolar soft part sarcoma

Angiosarcoma

Malignant peripheral nerve sheath tumour

Leiomyoma

Genital rhabdomyoma

Postoperative spindle cell nodule

Mixed epithelial and mesenchymal tumours

Carcinosarcoma (malignant Müllerian mixed tumour, metaplastic carcinoma)

Adenosarcoma

Wilms tumour

Adenofibroma

Adenomyoma

Melanocytic tumours

Malignant melanoma

Nevus cell nevus

Miscellaneous tumours

Tumours of germ cell type

Yolk sac tumour

Dermoid cyst

Mature cystic teratoma

Lymphoid and haematopoetic tumours

Malignant lymphoma

Leukemia

Secondary tumours

Table III. TNM categories and FIGO staging.

TNM	Explanation applicable to both systems	FIGO
Tx	Primary tumour cannot be assessed
T0	No evidence of primary tumour
Tis	Carcinoma in situ (preinvasive carcinoma)
T1	Tumour confined to the cervix (extension to corpus should be disregarded)	I
T1a	Invasive carcinoma diagnosed only by microscopy	IA
T1a1	Measured stromal invasion 3.0 mm or less in depth and 7.0 mm or less in horizontal spread	IA1
T1a2	Measured stromal invasion more than 3.0 mm and not more than 5.0 mm with a horizontal spread of 7.0 mm or less	IA2
T1b	Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a2/1A2	IB
T1b1	Clinically visible lesion 4.0 cm or less in greatest dimension	IB1
T1b2	Clinically visible lesion more than 4.0 cm in greatest dimension	IB2
T2	Tumour invades beyond uterus but not to pelvic wall or to lower third of vagina	II
T2a	Tumour without parametrial invasion	IIA
T2b	Tumour with parametrial invasion	IIB
T3	Tumour extends to pelvic wall, involves lower third of vagina, causes hydronephrosis or non-functioning kidney	III
T3a	Tumour involves lower third of vagina	IIIA
T3b	Tumour extends to pelvic wall, causes hydronephrosis or non-functioning kidney	IIIB
T4	Tumour invades mucosa of bladder or rectum, or extends beyond true pelvis	IVA
N1	Regional lymph node metastasis
M1	Distant metastasis	IVB

For details see Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours. 7^th ed. Wiley-Blackwell, UICC; 2009.

Figure 3. Staging of cervical cancer according to FIGO (Montreal, 1994) extracted from [44].

WHO. Pathology and genetics of tumours of the breast and female genital organs. Lyon: IARC Press; 2003.

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FIGO. FIGO annual report on the results of treatment in gynaecological cancer. 24th. J Epidemiol Biostat 2000;Special issue:x.

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