The tendon of the fibularis brevis muscle - Systematic overview and new classification system

The fibularis brevis muscle belongs to the lateral compartment of the leg. It originates from the lower two-thirds of the lateral surface of the fibula bone and it also is attached to the anterior intermuscular septum. Its insertion is normally located on the tuberosity at the base of the fifth metatarsal bone, on its lateral side. However, distal attachment of this muscle is morphologically variable. Different variations have been identified and some classification systems have been created for both adults and foetuses. Based on various literature references, we have created a new classification system and compared the frequency of each type. The main aim of this review is to present morphological variations of the fibularis brevis tendon with their clinical significance, especially in autografting in case of surgical treatment of fibularis brevis tendon rupture. The clinical aspect of this pathology and some medical cases will also be presented.

Embryological approach to the morphology of the ligamentum mucosum of the human knee joint

PURPOSE

The ligamentum mucosum is a ligamentous structure within the synovial layer of the knee joint capsule. It usually arises from the infrapatellar fat pad and is inserted into the intercondylar notch of the femur. In recent years, more attention has been paid to this structure because of its clinical significance. Despite the growing attention, the complex morphology of the ligamentum mucosum has led to many misunderstandings among the scientists and clinicians. Therefore, the main objective of this study was to characterize the morphology of the ligamentum mucosum and its attachment points, classify it, and evaluate its prevalence.

METHODS

Classical anatomical dissection was performed on 70 lower limbs of human fetuses fixed in 10% formalin solution. Morphology was carefully assessed, and morphometric measurements were performed. The types revealed were classified.

RESULTS

The ligamentum mucosum was present in 100% of all 70 specimens examined. Two types were detected. Type I (65.71%) - "cord-like". This type was the most common and is characterized by a single longitudinal ligament. The proximal attachment of the ligamentum mucosum was located in the middle of the infrapatellar fat, and the distal attachment was at the tip of the intercondylar notch. Type II (34.29%) - "vertical septum". This type is less common, but its morphology is much more complex compared to type I. It is wider and thicker than type I. Proximally, it is attached to the infrapatellar fat pad and distally through the entire intercondylar notch down to the anterior surface of the anterior cruciate ligament. It divides the joint cavity into medial and lateral sides.

CONCLUSION

The ligamentum mucosum exhibits high morphologic variability, and the view that it is a vestigial remnant of the embryologic development of the knee should be reconsidered. We have proposed an anatomical classification of its types in human fetuses, which is a valuable addition to existing knowledge and will hopefully change the approach of clinicians and scientists.

A proposal for a new classification of the Coracobrachialis longus: A rare case or a new, distinct muscle?

BACKGROUND

The coracobrachialis muscle, along with the brachialis and biceps brachii muscles, belong to the anterior group of the brachial region. It is characterized by high level of morphological variabilities, with a common variation being the coracobrachialis longus (CBL) muscle. The CBL may be recognized as a distal part of the coracobrachialis muscle, originating from the anteromedial surface of the humerus, however, the two muscles are distinct from each other, and the distal attachment of the CBL is longer and located closer to the elbow joint. The CBL muscle may also be inserted on to various structures. The aim of the present study was to determine the frequency of the CBL muscle among a studied population, and to prepare a classification based on its morphological features.

MATERIAL AND METHODS

Classical anatomical dissection was performed on 100 upper limbs from fifty human cadavers (30 female and 20 male) fixed in 10% formalin solution.

RESULTS

The coracobrachialis muscle was found in all individuals, and the CBL muscle was present in 11%, i.e. 11 upper limbs: four women, and seven men; five left and six right. Significantly, in all cadavers in which the coracobrachialis longus was found, its presence was unilateral (five left and six right). A new classification of the CBL can be proposed based on its insertion: Type I characterized by a distal attachment located on the medial epicondyle (73% of all cases of the CBL) and Type II by an insertion into the olecranon (27% of all cases of the CBL).

CONCLUSION

The CBL muscle is morphologically variable. More studies focused on the course of this muscle among various populations are needed. Nevertheless, our findings indicate that the CBL muscle could be classified as a distinct muscle.

Review of Difficulty Indices for Removal of Impacted Third Molars and a New Classification of Difficulty Indices

BACKGROUND

A number of efforts have been made to establish a reliable assessment model for the surgical removal of impacted third molars. Although many such models have been proposed, none is considered universally applicable, and controversy remains. The earlier attempts were based exclusively on radiographic variables, whereas recent evidence is associated with nonradiographic and demographic variables.

PURPOSE

This article aimed to prepare review of the relevant literature to summarize the important indices given till date, tabulating only new indices as old indices are mentioned in almost all text books, their merits and demerits and their specificity and sensitivity (if assessed in the literature). In addition to it, authors also aimed to introduce a new descriptive classification of all indices based on pre- and postoperative assessment and further classify based on clinical, radiographic and demographic factors, surgical technique and time. This article will be of academic and practical help for residents and clinicians.

METHOD

A literature search was conducted in Medline, PubMed, Google Scholar, Science Direct and Cochrane electronic database with keywords-impacted mandibular third molar, difficulty indices, validity of, sensitivity, specificity. No publication year limit was used. The abstracts of the articles were retrieved, reviewed and sorted based on the following inclusion and exclusion criteria. Articles which include a new index, validate difficulty index, compare two or more difficulty indices, specificity and sensitivity of particular index are included. Duplicate articles, articles on complication, flap design, drug study, radiographic relation of inferior alveolar nerve, suturing, classification, only assessing factor affecting difficulty of third molar surgery are not included.

RESULTS

Total 39 (36 articles + 3 books) are included. A total of 20 individual indices were found in the literature; each has been described in brief in this review. These indices are also listed in chronological order with their specificity and sensitivity if accessed in the literature.

CONCLUSION

There is a definite need to derive and validate an user-friendly index that could be used for preoperative prediction of difficulty. To the best of our knowledge, this review including all indices till date and classification proposed is the first on this subject.

A proposal for a new classification of coracobrachialis muscle morphology

Introduction

The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability.

Material and methods

One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined.

Results

Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished.

Conclusion

An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM.

What is known about this subject "and" What this study adds to existing knowledge

Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.

The subscapularis tendon: A proposed classification system

BACKGROUND

The subscapularis muscle originates from the medial two-thirds and from the lower two-thirds of the groove on the subscapular fossa of the scapula and inserts into the lesser tubercle of the humerus. Our initial hypothesis is that it shows little morphological variation. The aim of this study is to demonstrate and classify the morphological variability of the subscapularis muscle.

METHODS

Classical anatomical dissection was performed on 64 upper limbs (44 females, 20 males, 30 left and 34 right, fixed in 10% formalin). The mean age "at death" of the cadavers was 75.6 years (range 48-95), and the group comprised equal numbers of female and male adults (Central European population). Upon dissection, the following morphological features were assessed: the number of tendons of the SM, the type of insertion of each tendon of the SM, morphometric measurements of the SM.

RESULTS

Four types of morphology (based on number of tendons) were observed in the cadavers. Type I was characterized by a single band. This was the most common type, occurring in 43.7% of all cases. Type II was characterized by a double tendon (superior and inferior); it occurred in 9.4%. Type III had three tendons (superior, middle, and inferior). It was the rarest type (7.8% of cases). Type IV, called "multiband", was the second most common (39.1%) and was divided into five subtypes.

CONCLUSIONS

The subscapularis muscle is highly morphologically variable. Knowledge of particular types of insertion is essential for both clinicians (for example orthopedists, physiotherapists) and anatomists.

A cadaveric study of the morphology of the extensor hallucis longus - a proposal for a new classification

Background

Morphological variations of the EHL concern mainly the accessory tendons and the site of their insertion. The aim of our study is to present a new classification of the EHL.

Methods

Classical anatomical dissection was performed on 104 lower limbs (51 right, 53 left, fixed in 10% formalin solution).

Results

In the cadavers, three types of morphology (insertion and addidtional band) were observed. Type I, the most common type, was characterized by a single tendon that ends as an extensor hood on the dorsal aspect of the base of the distal phalanx of the big toe (57.7%). Type II was characterized by two distal tendons and was subdivided into three subtypes according to (A-29.9%, B-4.8% and C-5.7%). Type III was characterised by three distal tendons (two cases - 1.9%).

Conclusion

The EHL presents high morphological variability. Knowledge of particular types of insertion is essential for both clinicians and anatomists.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2688-8) contains supplementary material, which is available to authorized users.

Variations in terminal branches of the popliteal artery: cadaveric study

INTRODUCTION

Identifying the branching pattern of the popliteal artery (PA) is a vital step in planning radiological and surgical procedures involving the anterior and posterior tibial and fibular arteries. The aim of this study was to characterize the course and morphology of the terminal branches of the PA.

MATERIALS AND METHODS

The anatomical variations in the branching patterns of the anterior and posterior tibial and fibular arteries were examined in 100 lower limbs fixed in a 10% formalin solution. A dissection of the popliteal region of the leg was carried out according to a pre-established protocol, using traditional techniques. Morphometric measurements were then obtained twice by two researchers.

RESULTS

In most cases (72%) the PA divides to form the anterior tibial artery (ATA) and a common junction for the posterior tibial and fibular arteries (type I), which further splits into the fibular artery and the posterior tibial artery (PTA). This type was subdivided into two subgroups according to whether the ATA (subgroup a) or the common junction of the posterior tibial and fibular arteries (subgroup b) had the larger diameter. Other identified variations included division of the PA into the ATA and PTA-8% (type II), trifurcation-12% (type III), the division of the PTA into the ATA and FA-8% (type IV), and aplasia of the PTA-8% (type IV).

CONCLUSION

Although the typical PA branching type was observed, it can be classified further into two additional sub-types based on the diameter of the ATA and the common junction of the posterior tibial and fibular arteries.

The clinical characteristics and surgical results of smoking-related young pneumothorax

OBJECTIVE

Primary spontaneous pneumothorax is a common disease that develops in relatively young healthy patients. Although smoking is generally believed to have a negative effect on the lungs, some authors reported that smokers with primary spontaneous pneumothorax had significantly lower postoperative recurrence rates than nonsmokers. This unexpected result suggests that primary spontaneous pneumothorax is classified into two categories: smoking-related young pneumothorax and residual primary spontaneous pneumothorax. We compared these two categories to determine their characteristics and corresponding surgical results.

METHODS

Between January 2009 and December 2018, we enrolled 267 consecutive cases that underwent first surgery for primary spontaneous pneumothorax in our hospital. A total of 252 eligible cases (211 residual primary spontaneous pneumothorax and 41 smoking-related young pneumothorax) underwent evaluation. Smoking-related young pneumothorax cases were defined as cases with characteristic HRCT findings and smoking habit.

RESULTS

The mean ages for the residual primary spontaneous pneumothorax and smoking-related young pneumothorax groups were 25.9 ± 13.1 and 30.5 ± 6.9 years, respectively. The groups included 186 (88.2%) and 41 (100.0%) men, and the mean body mass indices were 19.1 ± 2.2 and 20.0 ± 1.9, respectively. Fifty-nine (28.0%) and 41 (100.0%) subjects were smokers, and there were 43 (20.4%) and 1 (2.4%) cases of postoperative recurrence, respectively. These results were significantly different between the two groups.

CONCLUSIONS

Individuals with smoking-related young pneumothorax were older, predominantly men, and had higher body mass index and significantly lower postoperative recurrence rates than those with residual primary spontaneous pneumothorax.

Characteristics of membranoproliferative glomerulonephritis based on a new classification at a single center

BACKGROUND

Recently, a new classification has been established for membranoproliferative glomerulonephritis (MPGN). However, the effect of the new classification on MPGN treatment is not fully understood.

METHODS

We conducted a retrospective study of 87 patients with biopsies diagnosed as MPGN. We reclassified 87 MPGN patients diagnosed between 1977 and 2014 at our hospital, according to the new classification, and analyzed both primary immune complex (IC)- and Alternative pathway (AP)-mediated MPGN [corrected] in terms of clinicopathological features, treatment, and renal prognosis.

RESULTS

Proteinuria was abundant in the IC-mediated MPGN group (p = 0.0063), and the serum albumin level was significantly lower in the IC-mediated MPGN group (p = 0.0186). The serum C3 value was significantly lower in the CP-mediated MPGN group (p = 0.0317). Serum CH50 values were also lower in the CP-mediated MPGN group (p = 0.0404). However, glomerular deposition of C3 showed no significant differences in immunofluorescence findings. The 148.6-month renal survival rate was similar in both groups (p = 0.445).

CONCLUSION

These results suggested no significant differences in complement activation of the solid phase in local glomeruli and therefore equivalent in renal prognosis [corrected].

A cadaveric and sonographic study of the morphology of the tibialis anterior tendon - a proposal for a new classification

Background

The tibialis anterior tendon (TAT) presents little morphological variation. The tibialis anterior muscle originates at the lateral condyle of the tibia, the proximal one-third to two-thirds of the lateral surface of the tibia shaft, and the anterior surface of the interosseous membrane and inserts to the medial cuneiform bone and first metatarsal. The aim of our work is to classify types of TAT insertion by two complimentary methods - anatomical dissection and ultrasound examination.

Methods

In the first part, classical anatomical dissection was performed on 100 lower limbs (50 right, 50 left) fixed in 10% formalin solution. The morphology of the insertion of the tendon was evaluated and the muscle was subjected to the appropriate morphometric measurements. In the second part, the morphology of the TAT insertion was evaluated in 50 volunteers with ultrasound.

Results

The tibialis anterior muscle was present in all specimens. In the cadavers, five types of insertion were observed, the most common being Type V: a single band attaching to the medial cuneiform bone (32%). In the sonographic part, Type IV was not observed; however, an additional insertion type was recognised (Type VI), which was characterized by two identical bands attached only to the medial cuneiform bone. The most common type identified by ultrasound was Type II (35%).

Conclusion

The tibialis anterior tendon presents high morphological variability that can be observed both in cadavers and in vivo by ultrasound examination.

Level of evidence

II Prospective Comparative Study

Electronic supplementary material

The online version of this article (10.1186/s13047-019-0319-0) contains supplementary material, which is available to authorized users.

A proposal for a new classification of pes anserinus morphology

PURPOSE

The pes anserinus (PA) is characterized by high morphological diversity. As the semitendinosus and gracilis muscle tendons are routinely harvested for the reconstruction of other tendons, especially the anterior cruciate ligament (ACL), it is of clinical importance. The presence of accessory bands within PA tendons can handicap the harvesting process. Therefore, the purpose of the study was to suggest a new morphological classification of the PA morphology.

METHODS

Classical anatomical dissection was performed on 102 lower limbs (56 right, 46 left) fixed in 10% formalin solution. The morphology and insertion of the PA (including accessory bands) were assessed, and morphometric measurements were taken.

RESULTS

In all cases, the PA was present and composed of the sartorius, gracilis and semitendinosus tendons. Six types of PA were distinguished based on the presence of accessory bands. The most common composed of monotendinous sartorius, gracilis and semitendinosus-54 limbs (52.9%). Additionally, three types of insertion were noted (short, band-shaped and fan-shaped). The mean length between the insertion and the origin of the accessory bands to the fascia of the gastrocnemius muscle was 63.5 mm.

CONCLUSION

The morphology of the PA was highly variable. The gracilis and semitendinosus tendons often had accessory bands that would complicate the harvesting process. The planning of surgical procedures may be improved by our proposed classification.

A proposal for a new classification of the fibular (lateral) collateral ligament based on morphological variations

BACKGROUND

The fibular collateral ligament (FCL) is subject to varus forces at all knee flexion angles and is also resistant to external rotation near extension. It originates on the lateral epicondyle of the femur and inserts on the lateral surface of the head of the fibula. However, its anatomical characteristics are inconsistent. Recent publications have focused on morphological variations concerning mainly femoral and fibular attachments, as well as morphometric measurements. Less attention has been paid to the morphology of the FCL and its relationship to the antero-lateral ligament (ALL).

QUESTION/PURPOSES

The aim of this paper is therefore to introduce the first complete classification of the FCL that includes all important aspects of morphological variability.

METHODS

Classical anatomical dissection was performed on 111 lower limbs (25 isolated and 86 paired) fixed in 10% formalin solution. The lateral compartment of the knee was investigated in detail.

RESULTS

The fibular collateral ligament was present in all specimens. The FCL originated most commonly (72.1% of cases) from the lateral femoral epicondyle, and the inserted on the lateral surface of the head of the fibula (Type I). In addition, bifurcated (Type IIa - 12.6%) and trifurcated (Type IIb - 0.9%) ligaments were also found with two and three distal bands, respectively. A double FCL was also found (Type III - 6.3%), as was fusion of the FCL and ALL (Type IV - 8.1%).

CONCLUSION

The FCL is characterized by high morphological variability. Knowledge of these variants is essential for surgeries performed in this region concerning the FCL and the ALL.

CLINICAL RELEVANCE

Distinguishing FCL from the FCL-ALL Complex is necessary when planning surgical procedures.

Periprosthetic acetabular fractures: A New classification proposal

INTRODUCTION

Acetabulum periprosthetic fractures are rare, but are increasing, due to increase in high-energy trauma and a decrease in mortality index. Reconstruction of an acetabular fracture, in the presence of hip arthroplasty can be very complex and represents a real challenge for orthopedic surgeon. Aim of this multicentric study is to classify periprosthetic acetabulum fractures and to propose a treatment algorithm.

MATERIALS AND METHODS

24 cases of acetabular periprosthetic fracture were treated surgically from 01.01.2010 to 31.04.2017 in three different hospitals; 4 males and 20 females, average age 76 years (range 56-90 years).

TREATMENT

4 cases treated conservatively, 8 cases ORIF, 2 cases treated with acetabular ring and screws, 9 cases ORIF and acetabular cup revision, 1 implant removal without revision.

RESULTS

All cases were reviewed at minimum 12 months follow-up. In 22 cases, there was no need for new surgical procedures and radiographically all implants appeared stable and with good bone integration. In a case of a type 1b fracture, a dislocation of prosthetic implant was observed after 3 months. In a case prosthesis was explanted and it was not possible to perform a revision.

DISCUSSION AND CONCLUSIONS

Fracture classification systems must facilitate communication between surgeons and encourage documentation and research. However, they should also have prognostic value, so from them should come directly a treatment algorithm. In our experience, most important factors as prognostic and therapeutic predictors were: implant stability and timing of fracture: intraoperative or postoperative. In postoperative fractures CT is mandatory to evaluate cup mobilization and fracture patterns. Our classification proposal is simple and easy to remember for daily use. From it is derived a simple treatment plan.

Anatomical variations of the palmaris longus muscle including its relation to the median nerve - a proposal for a new classification

BACKGROUND

The palmaris longus (PL) muscle is characterised by high morphological diversity, and its tendon crosses the median nerve (MN) at different levels. Due to the fact that the palmaris longus tendon is routinely harvested for reconstruction of other tendons, knowledge of its morphological variations is clinically important. Therefore, the purpose of the study was to suggest a new morphological classification of the PL muscle and characterise the relationship of its tendon to the median nerve.

METHODS

Standard dissection was performed on 80 randomised and isolated upper limbs (40 left and 40 right) fixed in a 10% formalin solution. Measurements of muscle belly and tendon were obtained. The course and location of tendon insertion, as well as its relationship to the median nerve, were noted.

RESULTS

The palmaris longus muscle was present in 92.5% of specimens. Three types of palmaris longus muscle were identified based on the morphology of its insertion (types I-III) and these were further subdivided into three subgroups (A-C) according to the ratio of the length of the muscle belly and its tendon. The most frequent was type I (78.8%), where the tendon attached to the palmar aponeurosis, and subtype B, where the tendon-to-belly ratio was 1-1.5 (41.1%). The mean distance from the interstyloid line to the crossing between the median nerve and the palmaris longus tendon was 31.6 mm. In addition, two types of palmaris longus were described.

CONCLUSION

The presented classification of palmaris longus muscle types allows a better characterization of its diversity and may be useful in planning tendon grafting.

New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures

PURPOSE

There are various types of intertrochanteric fractures that are unstable pertrochanteric fractures of the hip. The aim of this study was to develop a systematic and comprehensive classification of intertrochanteric fractures.

MATERIALS AND METHODS

This study enrolled 74 patients with intertrochanteric fractures treated by us between 2012 and 2015. The fractures were classified using 3D-CT images taken immediately after the fractures occurred based on the course of the lateral fracture line (LFL) that extends through the lateral femoral cortex distal to the vastus ridge of the greater trochanter in the intertrochanteric area. Furthermore, the presence or absence of additional typical fractures was also studied. Then, 4 orthopedic specialists examined the 3D-CT images of 20 patients randomly selected from the 74 patients to evaluate both the inter-rater and intra-rater agreement levels.

RESULTS

Intertrochanteric fractures were classified into three types according to the LFL patterns. Type I (41.9%), the Lateral Wall Pattern, has a LFL that extends towards the lateral fiber bundle attachment area of the iliofemoral ligament. Type II (24.3%), the Transverse Pattern, has a LFL that extends towards the medial bundle attachment area. Type III (33.8%), the Reverse Oblique Pattern, has a LFL that extends between the lateral and medial fiber bundle area of the iliofemoral ligament. Each type showed characteristic displacement and was associated with various combinations of typical fractures (fracture across the intertrochanteric line, posteromedial fragment, including the lesser trochanter, posterolateral fragment posterior to the femoral greater trochanter, and banana-shaped big fragment, including both the greater trochanter and the lesser trochanter). The mean κ values for the interobserver and intraobserver agreement levels were 0.77 (0.70-0.85) and 0.76 (0.70-0.85), respectively, which were considered substantial agreement levels.

CONCLUSION

We believe our new classification is a useful communication tool for medical professionals in the diagnosis of fractures.

Survival analysis of revised 2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification

Objective

To analyze the prognostic role of revised version of International Federation of Gynecology and Obstetrics (FIGO) stage (2013) in epithelial ovarian cancer and compare with previous version staging classification

Methods

We retrospectively enrolled patients with epithelial ovarian cancer treated at Samsung Medical Center from 2002 to 2012. We reclassified the patients based on the revised FIGO staging classification.

Results

Eight hundred seventy-eight patients were enrolled (stage I, 22.8%; stage II, 10.4%; stage III, 56.2%; stage IV, 10.7%). Previous stage IC (98, 11.1%) was subdivided into IC1 (9, 1.0%), IC2 (57, 6.4%), and IC3 (32, 4.1%). In addition, previous stage IV (94, 1.7%) was categorized into IVA (37, 4.2%) and IVB (57, 6.5%) in new staging classification. Stage IIC (66, 7.5%) has been eliminated and integrated into IIA (36, 4.1%) and IIB (55, 6.2%) in revised classification. Revised FIGO stage IC3 had significant prognostic impact on PFS (hazard ratio [HR], 3.840; 95% confidence interval [CI], 1.361 to 10.83; P=0.011) and revised FIGO stage IIIC appears to be an independent, significant poor prognostic factor for PFS (HR, 2.541; 95% CI, 1.242 to 5.200; P=0.011) but not in the case of previous version of FIGO stage IIIC (HR, 1.070; 95% CI, 0.502 to 2.281; P=0.860). However, any sub-stages of both previous and revised version in stage II and IV, there was no significant prognostic role.

Conclusion

Revised FIGO stage has more progressed utility for informing prognosis than previous version, especially in stage I and III. For stage II and IV, further validation should be needed in large population based study in the future.