In FIGO 2014 staging of ovarian carcinoma, which change from prior FIGO staging is most clinically significant for Stage I disease?
- A Stage IA and IB are no longer differentiated
- B Positive peritoneal cytology alone (without peritoneal metastasis) upgrades Stage I to Stage IIIA1
- C Capsule rupture during surgery is now Stage IC1, distinguishing it from pre-operative rupture (Stage IC2) and malignant cells in ascites (Stage IC3) ✓
- D Lymph node metastasis is now classified as Stage II instead of Stage IIIC
Explanation
The major FIGO 2014 revision subdivided Stage IC into three subgroups: IC1 (surgical spill/intraoperative rupture), IC2 (pre-operative rupture or capsule on ovarian surface), and IC3 (malignant cells in ascites or peritoneal washing). This subdivision has prognostic significance — IC1 (iatrogenic spillage) has a better prognosis than IC2 or IC3. Another key 2014 change was reclassifying retroperitoneal lymph node metastasis only (without other Stage III features) as Stage IIIA1 (not IIIC). Positive peritoneal cytology alone was removed from upstaging in 2014 in ovarian cancer, unlike endometrial cancer.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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