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ORIGINAL RESEARCH |
From the Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, and the Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts; the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Address reprint requests to: John O. Schorge, MD Department of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women’s Hospital 75 Francis Street Boston, MA 02115 E-mail: joschorge{at}bics.bwh.harvard.edu
Objective: To propose a definition for stage IA1 cervical adenocarcinoma, based on the International Federation of Gynecology and Obstetrics (FIGO) staging system, and to determine if patients meeting criteria might be candidates for conservative surgery.
Methods: Two hundred women were diagnosed with early-stage cervical adenocarcinoma from 1982 to 1996. Histopathologic sections were reviewed by a gynecologic pathologist. Medical records were reviewed, and patients included in this study had microscopically identifiable lesions, up to 3 mm invasive depth, up to 7 mm tumor width, and negative margins if cone biopsy was performed.
Results: Twenty-one patients with microinvasive adenocarcinoma met criteria for FIGO stage IA1 carcinoma of the cervix. The median (range) follow-up was 76 (30–172) months and median (range) patient age was 38 (24–75) years. Definitive treatment included type II or III radical hysterectomy in 16 cases, simple abdominal or vaginal hysterectomy in four cases, and loop electrosurgical excision procedure in one case; one patient received adjuvant pelvic radiation. The histologic subtypes were endocervical adenocarcinoma in 18 cases, adenosquamous carcinoma in two cases, and clear-cell adenocarcinoma in one case. There was no evidence of parametrial invasion or lymph node metastases in any patient who had radical surgery, and there were no disease recurrences.
Conclusion: Patients with microinvasive adenocarcinoma who met criteria for FIGO stage IA1 cervical carcinoma had disease limited to the cervix, and conservative surgery, such as cone biopsy or simple hysterectomy, might offer them definitive treatment.
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