The value of loop electrosurgical conization in the treatment of stage IA1 microinvasive carcinoma of the uterine cervix

Abstract

The objective of this study is to assess the value of Loop Electrosurgical Conization (LEC) in the treatment of stage IA1 microinvasive squamous cell carcinoma (MIC) of the uterine cervix. Retrospectively, 82 patients with FIGO stage IA1 MIC, primarily treated with LEC on see and treat basis, were analyzed. After the initial LEC, 16 patients received cytologic and colposcopic follow-up only, 66 patients underwent a second procedure (repeat LEC, Cold Knife Conization (CKC), or hysterectomy), and four patients underwent a third procedure (hysterectomy). In 63 patients (77%) no residual CIN 3 or MIC was present after the initial LEC. Treatment of residual CIN 3 or MIC was equally effective with a repeat LEC as with CKC. One patient defaulted follow-up and developed a recurrence in the vaginal vault and was treated with a radical hysterectomy. LEC can be used as an alternative for CKC in treatment of patients with stage IA1 MIC. The advantage of LEC is that it can be performed as an outpatient procedure in addition to a diagnostic colposcopy and does not require a major anesthetic. Only a small number of patients will need a more extensive procedure.

Diagnosis and management of cervical cancer

“…These women can be treated conservatively by simple hysterectomy or by conisation, if they wish to preserve fertility. 15 The importance of involvement of the lymphovascular space in stage IA1 disease is not clear, but most practitioners favour radical surgery or radiation if it is present. Radical hysterectomy is the treatment of choice for young healthy patients because it preserves ovarian function.…”

Epidemiological and clinical aspects of human papillomavirus detection in the prevention of cervical cancer

“…With LLETZ a cure rate of >90% can be achieved, even in case of micro-invasive disease, and close cytological follow-up after 6, 12 and 24 months is advised and necessary to detect any residual or recurrent CIN [103,104,[106][107][108]. However, follow-up cytology has a low specificity in detecting residual or recurrent CIN, and followup colposcopy is difficult in a post-treatment cervix [107].…”

Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years

“…The diagnosis and definition of microinvasion should be based on analysis of cervix conization specimens, 1 obtained by cold knife conization (CKC) or loop electrosurgical excision procedure (LEEP). 2,3 Since the first microinvasive cervix cancer reported in 1947, 4 there are discussions about the extent of treatment but until now there is no unified standard treatment. Management of women with MIC IA1 without lymph vascular space invasion (LVSI) varied from cervix conization to simple hysterectomy.…”

“…11Y13 Treatment plan for MIC without LVSI should also consider the risk of invasive disease in the residual cervix and risk of recurrence, and the most important parameters to define treatment extension and prognosis in those cases are depth of stromal invasion, conization margin involvement, and residual disease after cervical conization. 9,14Y16 Although it has been suggested by several retrospective studies that MIC has excellent prognosis and less radical surgery could be considered for these cases, 3,8,9,16 data regarding the risk and extent of residual disease in these settings are not uniform at this time. In the present study, we report a cohort of 139 women with MIC without LVSI treated conservatively or not and followed up to 20 years to explore appropriate treatment modality and analyze the prognosis and risk factors for recurrence.…”