STUDIES ON 200 CASES OF EARLY SQUAMOUS-CELL CARCINOMA OF THE CERVIX

Two hundred cases of early squamous cell carcinoma of the cervix were studied, 109 with early stromal invasion (ESI) (FIGO stage Ia1) and 91 microcarcinomas (MCs) (stage Ia2). Nine percent of invasive foci aros e from original (native) squamous epithelium, outside the transformati on zone. What may have been ''skip lesions'' (see text) were seen in o nly two instances. Of the cases of ESI, 78% invaded to less-than-or-eq ual-to 0.5 mm. Of the MCs, 65% invaded to less-than-or-equal-to 3 mm, and >50% measured less-than-or-equal-to 50 mm3 in volume. Capillary-li ke space involvement (CLSI) was suspected in 32 cases (29%) of MC on h ematoxylin and eosin (H&E) staining but could not be confirmed by Ulex europeaus agglutinin I lectin immunoperoxidase staining in 10. Forty- four MCs displayed a spray-like growth pattern, 34 a confluent pattern , and 12 both; one had a condylomatous appearance. Forty-eight MCs wer e grade 3, 27 were grade 2, and 16 were grade 1 in differentiation. St romal response was assessed as absent in nine cases, weak in 53, moder ate in 58, and intense in 80. The extent of associated cervical intrae pithelial neoplasia (CIN) was widespread in all but nine cases. There were seven recurrences, including one definite and one possible tumor- related death. A single case of residual disease was observed. The new FIGO classification of preclinical stage Ia carcinoma as that diagnos ed only by microscopy is sound. The division into stages Ia1 and Ia2 i s reproducible and may be used for comparison between various institut ions; the notion, however, that the length of MC should form part of i ts definition is not supported by these data. None of the variables (d epth of invasion, length, area, volume, growth pattern, grade, stromal response, and CLSI) had any bearing on prognosis. Although stromal in vasion can certainly be seen in small punch biopsies, a definitive dia gnosis can be made only in conization (or hysterectomy) specimens. It is absolutely essential that conization specimens be thoroughly sample d, not only to make the correct diagnosis but also to be certain about the margins. Early stromal invasion behaves in the same manner as CIN and may be treated by conization alone provided the cone has been ade quately sampled and the margins are free. Much the same applied to MC, although there were not enough patients whose tumors were associated with CLSI to be absolutely certain of the prognostic significance of t he latter.