Diagnosis And Treatment Of Microinvasive Cervical Cancer

ObjectivesTo compare the diagnosis and treatment of microinvasive cervical cancer(MIC)in Peking Union Medical College Hospital from 2014 to 2018 and from 2003 to 2013,to analyze the correlation between lymphatic vessel invasion(LVSI)and lymph node metastasis,the correlation between positive conization margin and residual lesions of surgical specimens,and to explore the feasibility and prognosis of repeat conization and fertility preservation in the treatment of microinvasive cervical cancer.MethodsRetrospectively review the clinical data of patients with microinvasive cervical cancer admitted to Peking Union Medical College Hospital from 2014 to 2018,summarize their clinical characteristics,diagnosis and treatment method,and compare with the data from 2003 to 2013,analyze the relationship between lymphovascular infiltration and lymph node metastasis,and between positive conization margin and residual lesions of surgical specimens.Characteristics of subgroups of repeat conization and fertility preservation were also summarized.ResultsFrom 2014 to 2018,491 patients with microinvasive cervical cancer were treated in Peking Union Medical College Hospital,431(87.8%)stage IA1 MIC and 60(12.2%)stage IA2 MIC.The median age of diagnosis was 42(37-48).1.52.9%of the patients were diagnosed with cervical lesions by health examination,which was significantly higher than 49.7%in 2003-2013.2.LVSI positive rate was 7.3%(30/413)and 16.4%(9/55)in IA1 MIC and IA2 MIC respectively.Lymph node metastasis rate was 0.7%(3/431)and 1.7%(1/60),respectively.No significant difference was found between IA1 MIC and IA2 MIC.LVSI predicts lymph node positivity by about 6.7%.There was no significant difference comparing with 7.1%in 2003-2013.3.The total positive rate of conization margin was 51.9%,which was significantly higher than 38.2%in 2003-2013.However,precancerous lesions were the main type of lesions in stage IA1 patients,and the proportion of invasive cancer was 12.9%,significantly lower comparing with 17.8%of invasive cancer in 2003-2013.There was no significant difference in the conization margin of IA2 patients between the two groups.In the comparison of lesion types at the conization margin,involved margin types and the residual lesions in surgical specimens in the subgroup who underwent operation within 90 days after the last conization,it was found that either margin lesion type or involved endvaginal,ectovaginal and both of the two can predict microinvasive cancer in surgical specimen very well.4.Twenty-three patients underwent repeat conization within 90 days,all of whom were IA1 MIC.Sixteen of them were followed up without futher treatment,while the other 7 patients were treated with subsequent simple hysterectomy.5.Thirty-seven patients were treated for fertility preservation purposes.Among them,31 patients with stage IA1 MIC and 6 with stage IA2 MIC.During the follow-up of 21.8 months(15.9-41.7),3 out of 15 patients with stage IA1 MIC who really want babies successfully had their pregnancy and their baby delivered.6.The average follow-up time of all patients was 27.2 months.There were 2 cases of recurrence.The DFS was 9.9 months and 10.4 months,respectively.The recurrence rate was 0.4%.Conclusions1.The positive rate of conization margin increased,however,the incidence of margin with invasive cancer involvement did not increase.And it has affected the choice of surgical methods.2.The status of conization margin is a good predictor for residual lesions,especially residual invasive cancer.3.FIGO 2018 has a significant impact on the diagnosis and treatment of MIC patients.