title: Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix.
abstract: BACKGROUND
  Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior.
  
  
  METHODS
  We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis.
  
  
  RESULTS
  Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.
  
  
  CONCLUSIONS
  MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.
authors.forename: Michikazu
authors.initials: M
authors.lastname: Nagura
authors.affiliation: Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. koshiyamam@nifty.com.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Koshiyama
authors.forename: Noriomi
authors.initials: N
authors.lastname: Matsumura
authors.forename: Aki
authors.initials: A
authors.lastname: Kido
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Baba
authors.forename: Kaoru
authors.initials: K
authors.lastname: Abiko
authors.forename: Junzo
authors.initials: J
authors.lastname: Hamanishi
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D003127:Colposcopy; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*