title: Clinical outcome of stage Ia1 squamous cell carcinoma of the uterine cervix and pathological findings of initial conization.
abstract: OBJECTIVE
  The present study investigated the clinical outcome of stage Ia1 squamous cell carcinoma (SCC) of the uterine cervix at a single institute.
  
  
  METHODS
  Subjects were 84 patients with cervical SCC, International Federation of Gynecology and Obstetrics stage Ia1 diagnosed according to conization findings between January 2000 and June 2009. Correlations between clinical outcome and pathological findings on initial conization were investigated.
  
  
  RESULTS
  Of 65 hysterectomy (without pelvic lymphadenectomy) patients, two (3.1%) showed metastasis to the vaginal wall, and two (3.1%) to the pelvic lymph nodes. Five patients (6.0%) showed lymphovascular invasion, and three (3.6%) showed confluent patterns of stromal invasion (confluent invasion) on initial conization findings. All of these five patients were included in the hysterectomy group. Of 19 patients with conization alone, two showed vaginal metastasis. Of four patients with vaginal metastasis, two showed lymphovascular invasion and one showed confluent invasion despite negative conization margin. In patients with nodal metastasis, stromal invasion of 3.0 mm and 2.8 mm, and horizontal spread of 6.8 mm and 6.9 mm were observed on conization, respectively. All patients are currently alive due to adequa\e therapy including chemo-radiation for six patients with recurrent disease.
  
  
  CONCLUSIONS
  In patients showing stromal invasion of nearly 3.0 mm and horizontal spread of nearly 7.0 mm in stage Ia1 cervical SCC, pelvic lymphadenectomy may be considered. Even for patients showing a negative conization margin, careful follow up is necessary, because vaginal metastasis sometimes occurs.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yoshinaga
authors.forename: Tomonori
authors.initials: T
authors.lastname: Hamada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Orita
authors.forename: Nao
authors.initials: N
authors.lastname: Yoshitomi Shintomo
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsuo
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsuji
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tabata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Douchi
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery*; D019092:Conization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*