Diagnosis and management of microinvasive (stage IA) carcinoma of the uterine cervix

Abstract

One hundred and sixty-two cases of Stage IA microinvasive carcinoma of the cervix are presented. These patients represent the combined experience at the University of Miami School of Medicine, Miami, Florida, and Downstate Medical Center, Brooklyn, New York. The criteria used in both institutions are 1) penetration of invasive carcinoma beneath the basement membrane of less than 1 mm and 2) absence of invasion of blood vessel or lymphatic spaces. All tissue specimens have been measured accurately by use of calibrated optics. The literature has been reviewed for criteria of diagnosis of microinvasive cancer, as well as methods of management. Our method of accurately determining depth of penetration is described and the evolution of microinvasive cancer is presented in a series of photomicrographs in which measurements are accurate to 0.1 mm. In the literature, when depth of penetration of up to 5 mm is used as criterion for microinvasive carcinoma, the incidence of nodal metastasis may be as high as 3.5%. Since, in our combined institutions, the mortality rate with radical hysterectomy is less than 1% and the incidence of ureterovaginal fistulas is 1.2%, we conclude that simple hysterectomy is not adequate therapy for lesions with stromal invasion to a depth of 5 mm.

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

“…The SGO definition does not comment on the width of the lesion. Clinical studies and expert opinion have generally concluded that ''microinvasive'' SCC can be managed conservatively by cervical conization, LEEP excision, or simple hysterectomy, although more restrictive depth criteria of 2 mm or even 1 mm have been proposed or used [98,[100][101][102][103][104][105][106][107][108][109][110][111][112][113].…”

Microinvasive Carcinoma of the Cervix

“…Lymph node metastasis is the single most important predictor of long-term outcome in patients with early cervical cancer, and there is a clear relationship between the depth of stromal invasion and the presence of lymph node metastasis. Lymph node metastasis is exceptional when the depth of stromal invasion is 1 mm or less, 4,12 and when the depth of stromal invasion is 3 mm or less the risk of lymph node metastasis is only about 1%. [22][23][24][25] When the depth of invasion is 3 mm or less, the risk of lymph node metastasis is sufficiently low that routine pelvic lymph node dissection is not necessary.…”

Das Plattenepithelkarzinom des kleinen Beckens nach zurückliegender Hysterektomie bei Benignität des Uterus - Kasuistiken und differenzialdiagnostische Darstellung

“…So wird in diesen Untersuchungen lediglich eine Treffsicherheit von 40 ± 45% für möglich gehalten [25,36]. Die Rezidivwahrscheinlichkeit von Mikrokarzinomen der Zervix liegt in Abhängigkeit von der ursprünglichen Invasionstiefe und den genannten Zusatzkriterien zwischen 1 und 5 % [3,6,7,11,28,41], (Tab. 2).…”