Early invasive (FIGO stage IA) carcinoma of the cervix: a clinico-pathologic study of 476 cases

Abstract

The clinical and histologic features of 476 tumors fitting the 1995 FIGO definition of stage IA cervical cancer, treated at a Sydney tertiary referral hospital between 1953 and 1992, are reviewed. Five-year follow-up was complete with a median of 10 years. The diagnosis was increasingly made by histologic examination of colposcopically directed cone biopsy. The majority (88%) of tumors were squamous. The proportion of both younger women (</=35 years) and adenocarcinoma and adenosquamous tumors increased during the second half of the study. Nearly half invaded 1 mm; a third 1.1-3 mm and 20% 3.1-5 mm. Lymph vascular space invasion (LVSI) increased with increasing depth of invasion and was present in over half the tumors invading >3 mm. Treatment was surgical in 99% and was increasingly more conservative as the study progressed with no apparent increase in treatment failure. From 1973 treatment by cone biopsy rose from 6.5 to 35%, by radical hysterectomy fell from 51 to 21% and by lymphadenectomy from 53 to 26%. Only one of 115 patients treated by cone biopsy died. Positive lymph nodes were detected in 1.7% of 180 patients undergoing lymphadenectomy. There were 16 recurrences (3.4%); six vaginal with no cancer deaths, nine pelvic and one distant, with nine deaths and three new cancers (two deaths). Univariate analysis suggests that older age, glandular tumors and those invading 3 mm were associated with more treatment failures and multivariate analysis showed that both conservative hysterectomy and the omission of lymphadenectomy are associated with higher recurrence rates with >3 mm invasion. The study failed to resolve the dilemma of predicting those tumors with a poor prognosis.

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 proportion of patients with lymph node metastases in FIGO IA1 or invasive carcinomas 3 mm or less in depth is negligible, and many authors have concluded that local excision is adequate management [97,121,[126][127][128][129][130][131][132][133]. Nevertheless, some have adopted the presence of LVI, or ''extensive'' LVI, as an exclusion criterion for conservative management [105,110,111,134].…”

“…Nevertheless, some have adopted the presence of LVI, or ''extensive'' LVI, as an exclusion criterion for conservative management [105,110,111,134]. In contrast, there is an increased prevalence of both lymph node metastases and recurrence after local excision in FIGO IA2, and many studies conclude that local excision alone is inadequate for this group of patients [39,103,118,126,128,130,[134][135][136][137][138].…”

Surgical Treatment Outcomes in Patients with Stage pT1a and pT1b1 Cervical Cancer

“…For depth of invasion of < 3 mm, LVSI has been reported in 4.5 -29% of patients, but increasing to 11.1-46.7% for depth of invasion of 3.1-5.0 mm 16) . The incidence of positive nodes in patients with stage I A1 disease has been reported to be 0.5-0.8% 17,18) . The overall incidence of lymph node metastases in patients with depth of invasion of 3-5 mm has been reported as 7.1%, although this varies from 0% to 13.8% 15,[19][20][21][22][23] .…”

Cervical Cancer: General Overview

“…The reported incidence of lymph metastasis in each FIGO stage of cervical cancer is as follows: stage IA1: 0-0.8 %; stage IA2: 0-7.4 %; stage IB: 11.7-23.2 %; stage IIA: 10.0-26.8 %; stage IIB: 35.2-48.6 % (Buckley et al 1996;Cosin et al 1998;Creasman et al 1998;Elliott et al 2000;Hirai et al 2003;Kasamatsu et al 2002;Lee et al 1989Lee et al , 2006Östör and Rome 1994;Poynor et al 2006;van Meurs et al 2009). The lymphatic spread of cervical cancer usually occurs in an orderly fashion from the pelvic lymph nodes, most commonly the obturator or external iliac lymph nodes, to the common iliac lymph nodes, and then the para-aortic lymph nodes (PALN).…”