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Clinical Value of Cold Knife Conization as Conservative Management in Patients With Microinvasive Cervical Squamous Cell Cancer (Stage IA1)

He, Yue MD*; Wu, Yu-Mei PhD*; Zhao, Qun PhD*; Wang, Tong MD*; Wang, Yan MD*; Kong, Wei-Min PhD*; Song, Fang MD*; Duan, Wei MD*; Zhu, Li MD; Zhang, Wei-Yuan PhD*‡

International Journal of Gynecological Cancer: September 2014 - Volume 24 - Issue 7 - p 1306–1311
doi: 10.1097/IGC.0000000000000199
Cervical Cancer

Objective The aim of the study is to evaluate the clinical value of cold knife conization (CKC) as a conservative management in patients with microinvasive cervical squamous cell cancer (SCC).

Methods This retrospective study enrolled 108 women with diagnosis of microinvasive cervical SCC (stage IA1) by pathology between 2009 to 2012 at Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Eighty-three patients underwent further hysterectomy.

Results Of the 83 patients (76.9%) who underwent further hysterectomy, 48 patients (57.8%) underwent extrafascial hysterectomy, 30 patients (36.1%) underwent extensive hysterectomy, and 5 patients (6.1%) underwent radical hysterectomy. A total of 19 patients underwent pelvic lymph node dissection without any lymph node metastasis, and a total of 5 patients (4.6%) had lymph vascular space invasion without any positive pelvic lymph node dissection. Of the 83 patients who underwent further hysterectomy and were followed up for 1 year, 18 patients with positive resection margins indicating cervical residual lesions (CIN1-3) have greater likelihood than 65 patients with clear resection margins, but there were no significant differences (P = 0.917); of the 25 patients who underwent CKC as final therapy and were followed up for 1 year, 2 patients with positive resection margins had the second CKC surgery, 1 was diagnosed with CIN1, and the other was diagnosed with cervicitis by pathology; 23 patients had clear resection margins, 2 patients underwent the second CKC 3 months after the first CKC because of the abnormal Thinprep Cytologic Test (TCT) result, and they were both diagnosed with microinvasive cervical SCC (stage IA1) by pathology with clear resection margins. No one enrolled in this study presented metastasis and progression within 1 year of follow-up.

Conclusions These findings provide the clinical evidences for the possibility of fertility-sparing treatments, especially CKC as conservative treatment for microinvasive cervical SCC. Appropriate further treatments (the second CKC) and follow-up are recommended for patients who strongly desire fertility sparing.

Departments of *Gynecologic Oncology, †Pathology, and ‡Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

Address correspondence and reprint requests to Yu-Mei Wu, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Qi-he-lou St, No. 17, Dongcheng District, Beijing 100006, China. E-mail: wym597118@163.com.

Supported by grants from the Beijing Municipal Science and Technology Commission (D0906008040391 and D09050703570902).

The authors declare no conflicts of interest.

Received March 13, 2014

Received in revised form May 13, 2014

Accepted May 13, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.