Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization

Abstract

Objective: To evaluate the efficacy of cold knife conization with electrocauterization and the feasibility of conservative management in patients with stage IA1 carcinoma of the cervix according to margin status after conization. Methods: Medical and histopathological records of 108 patients with stage IA1 cervical carcinoma were reviewed retrospectively. Patients underwent cold knife conization with electrocauterization or conization followed by hysterectomy. Disease recurrence was defined as a histologic diagnosis of cervical intraepithelial neoplasia (CIN) 2 or higher grade lesion. Results: Forty patients underwent conization followed by hysterectomy; of 27 women with positive margins, 14 (35%) had a residual lesion. Sixty-eight patients underwent conization without further surgical intervention. Forty patients had a negative resection margin without recurrence, while 28 had a positive resection margin: positive exocervical (n = 11), positive endocervical (n = 17). Among these, there were 7 cases of recurrence: positive exocervical (n = 1); positive endocervical (n = 6). Conclusion: Cold knife conization with electrocauterization appears to be a safe treatment option for patients with stage IA1 cervical carcinoma if careful follow-up is guaranteed for patients with CIN 3 exocervical resection margins. However, patients with CIN 3 endocervical resection margins should be managed surgically with repeat conization or hysterectomy. Crown

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

“…Persistent or recurrent cervical disease may occur in women with negative margins or those involved by SIL, and both groups remain at risk for persistent or recurrent SIL [98]. Women with involved margins are at increased risk for both the presence of multifocal invasive squamous carcinoma and persistent SIL [96,137,[139][140][141][142][143]. Clinical follow-up or immediate reexcision may be chosen in the management of women with SIL at the surgical margins.…”

Safety of less aggressive surgery for stage IA1 squamous cell carcinoma of the cervix

“…These studies defined residual disease as more than CIN II. Furthermore, residual disease in hysterectomy specimens was not found for women who had negative resection margins and was instead found only in those who had positive resection margins …”

“…The low risk of residual tumor has been observed in previous studies, particularly for stage IA1 squamous cell carcinomas with negative margins following conization . Previous investigators have found that the incidence of residual disease is significantly lower in patients with negative margins than in those with positive margins . Some reported that the risk of residual disease was 11.1% (3/27) for patients treated with a hysterectomy following conization in line with patients' wishes, with negative margins for cervical intraepithelial neoplasia (CIN) and no LVSI .…”

Clinical Value of Cold Knife Conization as Conservative Management in Patients With Microinvasive Cervical Squamous Cell Cancer (Stage IA1)

“…13 Patients who had CKC have better quality of life and sex than patients who had hysterectomy and RTas treatment of microinvasive cervical SCC. 14 It has been reported that important prognostic factors with early-stage cervical SCC are tumor volume, LVSI, and PLND. Most patients with clinical stage IA1 have small tumor, negative PLND, and negative LVSI.…”

“…As long as it fulfilled the requirements of fertility sparing, CKC could be the preferred surgery under close follow-up, and hysterectomy and PLND may not be required. 14,16 The National Comprehensive Cancer Network (NCCN) clinical practice guidelines on earlystage cervical SCC treatment recommendations were as following: the patients without lymph node invasion who have fertility requirements or were not suitable for hysterectomy should undergo fertility-sparing surgery (including CKC); and patients who have no fertility requirements could undergo hysterectomy. 17 We found that some young and nulliparous patients who had stage IA1 microinvasive cervical SCC with clear resection margins after CKC considered CKC operation as the final therapy.…”