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Recent Developments in Defining Microinvasive and Early Invasive Carcinoma of the Uterine Cervix

Bean, Sarah M. MD1; Kurtycz, Daniel F.I. MD2; Colgan, Terence J. MD3

Journal of Lower Genital Tract Disease: April 2011 - Volume 15 - Issue 2 - pp 146-157
doi: 10.1097/LGT.0b013e3181fb425d
Review Articles

Although only a small proportion of invasive squamous carcinoma of the cervix present with microinvasive disease, consistent recognition of this entity is important because it carries important management implications. The objective of this review was to reassess the methods and criteria for a histopathologic diagnosis of both early invasive squamous and adenocarcinomas in light of recent pathologic and clinicopathologic studies. The diagnosis of microinvasion is primarily histopathologic. Although the concept of microinvasion initially seems obvious, there are problems in diagnostic precision. A clear understanding of both the Society of Gynaecologic Oncologists' and the International Federation of Obstetricians and Gynecologists' classifications of early invasive disease is required. Subsequently, key parameters must be assessed-measurement of depth and lateral spread, assessment of margins, and identification of lymphovascular invasion-using accepted reference points and definitions. This assessment requires properly oriented and stained histologic sections of a loop electrosurgical excision procedure or cone specimen. Immunohistochemical staining of vascular endothelium or epithelial basement membrane has only a limited/adjunctive role. Controversy continues regarding the need to appraise the extent of any lymphovascular invasion and measurement in cases with multifocal invasion. Application of criteria to invasive adenocarcinomas seems warranted but is particularly challenging because of its special morphology and different biology.

The diagnosis of early invasive carcinoma of the cervix requires meticulous histopathologic examination of the entire lesion and adherence to diagnostic criteria.

1Duke University Medical Center and Department of Pathology, Duke University, Durham, NC; 2Wisconsin State Laboratory of Hygiene and Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; and 3Mount Sinai Hospital and Departments of Laboratory Medicine and Pathobiology and Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada

Correspondence to: Terence J. Colgan, MD, Mount Sinai Hospital, Room 6-502-3, 600 University Ave, Toronto, Ontario, Canada M5G 1X5. E-mail: tcolgan@mtsinai.on.ca

This article was prepared without formal financial support. The authors have declared no conflict of interest in this subject material.

©2011The American Society for Colposcopy and Cervical Pathology