Korean J Obstet Gynecol.  1999 May;42(5):1079-1084.

Therapeutic Conization of Microinvasive Carcinoma of the Uterine Cervix

• Ahn YD
• Yang SH
• Chae HJ
• Kang GJ
• Yoon MS

Abstract

Microinvasive squamous cell carcinoma of the cervix is a subject associated with decades of confusion and multiplicity of definitions. And so the treatment of microinvasive squamous cell carcinoma of the cervix is controversial. Simple hysterectomy has been performed in almost all cases, associated or not with more radical procedures. But the morbidity associated with simple hysterectomy or more radical procedures must be weighed against the possibility of residual neoplasia. Currently, there is a tendency to adopt conservative management to treat patients with microinvasion, as long as it can be assured that the whole lesion has been removed. This study was made to investigate clinical aspects of microinvasive squamous cell carcinoma of the cervix and to establish which histological informations should be obtained from the cones that would give the best possible assurance of absence of residual neoplasia in the patient. This was done by comparing cone and hysterectomy specimens from each patient. Sixty nine cases who were diagnosed with microinvasive squamous cell carcinoma of the cervix and treated at Pusan National University Hospital from 1993 to 1997 were presented. Eight of these patients have been done conization as a therapeutic modality. We evaluated the following histological features in the cones: depth of invasion, lymphovascular invasion, morphological signs of HPV infection, and free or involved cone surgical margins. Residual neoplasia in the hysterectomy specimen was more frequent when margins of the cones were involved by atypical epithelium and in cases with signs of HPV infection. In conclusion, preoperative correct diagnosis of microinvasive cervical carcinoma was not easy and diagnostic conization should be done for correct diagnosis. Patients with a depth of invasion of 3 mm or less without signs of HPV infection and lymphovascular invasion safely can be treated with therapeutic conization. It cannot be overemphasized, however, that when conservative treatment is chosen, a close follow up with cytological and colposcopic control is indispensable.

Keyword

microinvasive cancer; conization; uterine cervix

MeSH Terms

Busan
Carcinoma, Squamous Cell
Cervix Uteri*
Conization*
Diagnosis
Epithelium
Female
Follow-Up Studies
Humans
Hysterectomy