Surgical Treatment of Microinvasive Cervical Cancer: Analysis of Pathologic Features With Implications on Radicality

Abstract

Patients with positive margins in cone biopsy specimens have an increased risk of residual disease at radical hysterectomy and require careful evaluation before conservative surgery. Pelvic lymph node evaluation is essential because lymph node metastasis may occur even in early stages. The lack of parametrial invasion in this study reinforces the knowledge that the select group of patients with microinvasive cervical carcinoma stages IA1 LVSI and stage IA2 have a very low risk of parametrial infiltration. Less radical surgery can be carefully considered for these patients.

Cervical Cancer, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

“…In studies of patients who had positive margins after conization, predictors of residual disease included positive endocervical curettage, combined endocervical margin and endocervical curettage, and volume of disease. 30,145,146 For patients with stage IA1 disease with LVSI, conization (with negative margins) plus laparoscopic pelvic SLN mapping/lymphadenectomy is a reasonable strategy. In addition, these patients may also be treated with a radical trachelectomy and SLN mapping/pelvic lymph node dissection [see "Primary Treatment (Fertility Sparing)," page 66].…”

“…In addition, these patients may also be treated with a radical trachelectomy and SLN mapping/pelvic lymph node dissection [see "Primary Treatment (Fertility Sparing)," page 66]. 59,[144][145][146][147][148][149][150] After childbearing is complete, hysterectomy can be considered for patients who have had either radical trachelectomy or a cone biopsy for early-stage disease if they have chronic, persistent HPV infection, they have persistent abnormal Pap tests, or they desire this surgery.…”

“…Less radical surgical approaches for patients with stage IA2 disease are the subject of ongoing investigation. 146,153 Pelvic external beam RT (EBRT) with brachytherapy (traditionally 70-80 Gy to total point A dose) is a treatment option for patients who are medically inoperable or who refuse surgery. 154 These doses are recommended for most patients based on summation of conventional external-beam fractionation and low dose-rate (40-70 cGy/h) brachytherapy equivalents.…”

End of the minimal invasion surgery in cervical cancer?

“…Less radical surgical approaches for patients with stage IA2 disease are the subject of ongoing investigation. 162,169 NCCN Guidelines Index Table of Contents Discussion…”

“…patients with positive margins after cone biopsy, options include repeat cone biopsy to better evaluate depth of invasion or a radical trachelectomy. In studies of patients who had positive margins after conization, predictors of residual disease included positive endocervical curettage, combined endocervical margin and endocervical curettage, and volume of disease [160][161][162]. After childbearing is complete, hysterectomy can be considered for patients who have had either radical trachelectomy or a cone biopsy for early-stage disease if they have chronic, persistent HPV infection, they have persistent abnormal Pap tests, or they desire this surgery.…”