Clinicopathologic features of early adenocarcinoma of the cervix initially managed with cervical conization.
OBJECTIVE
To evaluate the clinicopathologic features of microinvasive adenocarcinoma of the cervix in order to guide the management of patients with this disease.


METHODS
A retrospective review was conducted of patients diagnosed with early invasive, <or=5 mm stromal invasion, adenocarcinoma of the cervix by a cervical conization between 1992 and 1999 at our institution. Information was abstracted on tumor histopathologic type, grade, and depth of invasion as well as presence or absence of disease at the margins of conization, lymphovascular spread, and the presence of disease in subsequent pathology specimens including the parametrium and pelvic lymph nodes (PLNs).


RESULTS
Thirty-three patients were identified. The mean age of the patients in the study population was 41.6 years (range, 29-53 years). Fifteen women were age 35 years or younger. Six patients had invasion<or=1 mm, 9 patients had invasion>1 mm and <or=2 mm, 6 patients had invasion>2 mm and <or=3 mm, 6 patients had invasion>3 mm and <or=4 mm, and 6 patients had invasion>4 mm and <or=5 mm. Three patients were treated with a conization only, 4 patients were treated with a simple hysterectomy, 25 patients were treated with a radical hysterectomy (RH) and PLN dissection (PLND), and 1 patient was treated with a radical trachelectomy and PLND. Ten patients had positive conization margins for invasive cancer, 3 patients had margins positive for adenocarcinoma in situ, 14 patients had negative margins, and in 6 patients the margin status could not be evaluated. Of the 10 patients with positive margins, 5 of 10 (50%) had residual disease in the subsequent surgical specimen. Three patients who underwent definitive management with conization alone originally had positive margins, underwent a second repeat conization, and are included in this group. Of the 16 patients with negative margins, no patient had residual disease in a subsequent surgical specimen. Of the 25 patients who underwent a RH and PLND, none had parametrial involvement and none had PLN involvement. All patients remained without evidence of disease at median follow-up of 30 months.


CONCLUSIONS
Historically, the standard management of early invasive adenocarcinoma of the cervix has been controversial, and some clinicians continue to favor radical treatments. Based on the absence of parametrial spread and PLN involvement in early lesions, physicians and patients should consider treatment with conization with negative margins (when future fertility is desired) or simple hysterectomy. Prospective studies are required to document the safety of this approach.
Poynor
E A
EA
Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Marshall
D
D
Sonoda
Y
Y
Slomovitz
B M
BM
Barakat
R R
RR
Soslow
R A
RA
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D019092:Conization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008499:Medical Records; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009519:New York City / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010388:Pelvis; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery*