Management of Stage IA carcinoma of the cervix

Creasman, William T.; Fetter, Bernard F.; Clarke‐Pearson, Daniel L.; Kaufmann, Louise A.; Parker, Roy T.

doi:10.1016/0002-9378(85)90105-x

Cited by 103 publications

(48 citation statements)

References 7 publications

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“…Microinvasive squamous carcinoma was defined according to the histologic criteria set forth by The Society of Gynecological Oncologists (SGO), namely 'one in which neoplastic epithelium invades the stroma in one or more places to a depth of 3 mm or less below the basement membrane of the epithelium and in which lymphatic or blood vascular involvement is not demonstrated. 22 Formalin-fixed, paraffin-embedded tissue blocks were sectioned at 5-mm intervals, deparaffinized in ProPar clearant (Anatech Ltd, Battle Creek, MI, USA) twice for 10 min, and hydrated gradually through graded alcohols (100% ethanol twice and 95% ethanol twice). To enhance the immunostaining, an antigen retrieval procedure was performed.…”

Section: Methodsmentioning

confidence: 99%

Maspin expression in CIN 3, microinvasive squamous cell carcinoma, and invasive squamous cell carcinoma of the uterine cervix

Quddus

Sung

et al. 2005

Modern Pathology

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Maspin is a serine protease inhibitor with tumor suppression activity. It is expressed in normal breast and prostate tissue but is downregulated or absent in breast and prostate tumors. Recent reports have shown that decreased expression is associated with a greater propensity for metastasis in oral squamous cell carcinomas. We know that some high-grade cervical intraepithelial neoplasia progress to invasive carcinomas while others either persist at the same degree of atypia or regress. The pattern of maspin expression in cervical intraepithelial neoplasia-grade 3, microinvasive squamous carcinomas and overtly invasive squamous cell carcinomas of the uterine cervix was studied to determine the relationship between the extent of maspin expression and the progression of cervical intraepithelial neoplasia to squamous cell carcinoma. In total, 36 cases were evaluated: 18 cases of cervical intraepithelial neoplasia-grade 3, seven cases of microinvasive squamous cell carcinoma and 11 cases of invasive squamous cell carcinoma. A monoclonal antibody was used on paraffin-embedded tissues. Immunoreactivity was scored semiquantitatively using a scale of 0-3. The sums of the scores of the different groups were compared using the Mann-Whitney U-test. A significant decrease in maspin scores was noted between cervical intraepithelial neoplasia-grade 3 vs invasive squamous cell carcinoma (Po0.005), microinvasive squamous cell carcinoma vs invasive squamous cell carcinoma (Po0.05), and cervical intraepithelial neoplasia-grade 3 vs tumor emboli (Po0.005). Although not statistically significant, scores of cervical intraepithelial neoplasia-grade 3 associated with invasive squamous cell carcinoma were lower compared to that cervical intraepithelial neoplasia-grade 3 without invasive squamous cell carcinoma. These findings suggest that maspin likely plays a role in disease progression from in situ to invasive carcinoma. Virtual absence of maspin immunopositivity in tumor emboli indicates that maspin may also play a role in metastasis. Maspin was identified as a tumor suppressor gene by subtractive hybridization from normal mammary epithelial cells. 1 It is a member of the serine protease inhibitor serpin superfamily and is located at 18q21.3, along with other serpin genes such as squamous cell carcinoma antigens 1 and 2 and PAI-2. 2 Accumulated evidence has demonstrated its role as a tumor suppressor that both inhibits cell motility and enhances the capacity for invasion and metastasis in breast cancer. [3][4][5][6][7][8] In addition, maspin expression is downregulated in prostate carcinoma cell lines and is frequently absent in primary prostate cancers. [8][9][10][11][12][13] Recent studies showed the regulation of maspin in response to androgen ablation of prostate cancer, which strongly implies that maspin plays a physiological role in growth inhibition 9 and engenders a sensitizing effect on apoptosis. 14 Oral squamous cell carcinomas that are immunopositive for maspin show a longer disease-free interval and overall survival per...

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Section: Methodsmentioning

confidence: 99%

Maspin expression in CIN 3, microinvasive squamous cell carcinoma, and invasive squamous cell carcinoma of the uterine cervix

Quddus

Sung

et al. 2005

Modern Pathology

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“…Initially, invasive squamous carcinomas as deep as 5 mm, regardless of LVI, were considered to be amenable to conservative therapy, but evidence accumulated that metastatic lymph node disease and/or local recurrence occurred in a small, but significant proportion of these patients [94][95][96][97]. Consequently, more restrictive definitions of minimally invasive squamous carcinoma were proposed.…”

Section: Site-specific Recommendationsmentioning

confidence: 99%

“…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].…”

Section: Site-specific Recommendationsmentioning

confidence: 99%

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

Darragh

Colgan

Cox

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

641

372

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The terminology for human papillomavirus (HPV)–associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.

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“…The significance of lymphovascular space invasion is not mentioned in the staging by FIGO, although it is a poor prognostic factor. 22 It is, therefore, difficult to say whether lymphovascular space invasion should be disregarded when planning treatment for stage Ia1 disease. It is also not known whether lymphovascular space invasion in stage Ia1 increases the risk of lymph node metastases.…”

Section: Managementmentioning

confidence: 99%

“…21,22 The majority of these cases are usually diagnosed on cone biopsy of the cervix or, more commonly, following large loop excision of the transformation zone (LLETZ). If the excision margins are clear of the disease (and of CIN) no further treatment is necessary.…”

Section: Managementmentioning

confidence: 99%

The current management of cervical cancer

Abu

Nunns

Davies

et al. 2004

The Obstetric & Gynaecologis

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Cervical cancer is a common cause of death worldwide. In the developed world, cervical cancer screening has successfully reduced the incidence of and mortality from the disease. Mortality remains high among developing nations. Over the past decade, there have been various developments in management strategies, based on currently available evidence. This review explores such evidence and recommends current management strategies, including fertilitysparing surgical options for early‐stage disease.

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Management of Stage IA carcinoma of the cervix

Cited by 103 publications

References 7 publications

Maspin expression in CIN 3, microinvasive squamous cell carcinoma, and invasive squamous cell carcinoma of the uterine cervix

Maspin expression in CIN 3, microinvasive squamous cell carcinoma, and invasive squamous cell carcinoma of the uterine cervix

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 current management of cervical cancer

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