MICRO-INVASIVE SQUAMOUS-CELL CARCINOMA OF THE CERVIX - A CLINICOPATHOLOGICAL STUDY OF 200 CASES WITH LONG-TERM FOLLOW-UP

The clinico-pathologic details of 200 patients with micro-invasive squ amous-cell carcinoma of the cervix have been analyzed. All tumors inva ded 5 mm or less below the basement membrane. One hundred and nine wer e categorized as FIGO stage 1a1 (early stromal invasion) and 91 as FIG O stage 1a2 (micro-carcinoma). The horizontal spread (length) of 12 mi cro-carcinomas exceeded 7 mm. Twenty-three had stromal invasion 3 mm o r more, and 22 had capillary-like space involvement. Fifty-eight patie nts underwent pelvic lymphadenectomy in addition to hysterectomy and n one had positive nodes. Univariate and multivariate analyses of possib le prognostic factors including depth, horizontal spread, width, area, volume, grade, growth pattern, capillary-like space involvement, and stromal reaction failed to show any to be significantly associated wit h recurrence. The median duration of follow-up is now 8 years (0-22 ye ars). Despite complete resection, seven (3.5%) patients developed recu rrence of in situ or invasive carcinoma (three after early stromal inv asion and four after micro-carcinoma), all of which were located at th e vaginal vault. There were two deaths, one due to pulmonary squamous- cell carcinomatosis 21 years after early stromal invasion, the connect ion being tenuous, and the other due to local recurrence. There have b een no recurrences to date in 23 patients treated by conization alone. The uniformly good prognosis of patients in this study is attributed to meticulous sampling of operative specimens resulting in accurate di agnosis and appropriate treatment, which may be conization alone provi ded the margins are free, there is no capillary-like space involvement , and the depth of penetration is less than 3 mm.