MICROINVASIVE CARCINOMA OF THE UTERINE CERVIX - CLINICAL-PATHOLOGIC STUDY

Of 265 patients accessioned to a study of microinvasive carcinoma of the cervix by participating institutions in the Gynecologic Oncology Group, 132 were rejected after preliminary review because of no evidence of invasion (99 patients), invasion in excess of 5 mm. (18 patients), inadequate conization (nine patients), and protocol violations (six patients). The data available for the 133 evaluable patients included clinical patient information, operative reports, narrative pathology reports, and microscopic slides. Tumor penetration was less than 2 mm. in 90 patients (67.5 per cent) and greater than 3 mm. in 21 patients (16 per cent). Lateral tumor extension was less than 4 mm. in 76 patients (57 per cent) and wider than 8 mm. in 29 patients (22 per cent). Extensive lateral spread was observed more frequently than deep penetration. Positive correlation was noted between the depth of penetration and lateral extension. Capillary-like space invasion by tumor was noted in 31 cases (23 per cent) and increased with depth of penetration. Lack of tumor differentiation occurred in patients with less than 1 mm. penetration more frequently than in those with deep penetration. A confluent pattern of tumor was observed more frequently with advanced depth of penetration and greater lateral spread. There was a strong correlation with residual tumor on hysterectomy specimen and capillary-like (CL) space involvement with deep stromal penetration and extensive lateral spread. No positive lymph nodes were observed in the 74 patients treated by radical hysterectomy and recurrence was noted in two patients with extensive CL space involvement. Conization specimens with surgical margins involved with cancer are inadequate for diagnosis of microinvasion and constitute a clear indication for management as a frankly invasive lesion. Simple hysterectomy may be the mode of therapy in patients with questionable invasion, with invasion less than 2 mm. in depth and 4 mm. in width, and without evidence of CL space invasion. Such conservative treatment is unwarranted if the conization margin is inadequate, if the margins are not clear, if invasion is deeper than 2 mm., if lateral spread is greater than 4 mm., or if tumor is present in the CL spaces. © 1979.