Female Pelvic Medicine & Reconstructive Surgery:
1Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, MN; 2Obstetrics and Gynecology, University of Southern California, Los Angeles, CA; 3Pathology and Laboratory Medicine, Mayo Clinic Rochester, Rochester, MN; 4Surgical Pathology, University of Southern California, Los Angeles, CA
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: None.
The purpose of this multi-center investigation was to investigate the risk of metastatic disease at presentation or by virtue of subsequent recurrence in microinvasive adenocarcinoma of the cervix (MIAC). This will allow us to identify those MIAC patients who can be safely treated conservatively reducing sequelae of overtreatment.
MATERIALS AND METHODS:
Institutional Review Board approval was obtained from both Mayo Clinic Rochester (MCR) and University of Southern California (USC). Inclusion criteria were: FIGO stage IA1 or IA2 cervical carcinoma; adenocarcinoma histology, and: patients surgically managed. Sixty-six patients met inclusion criteria (MCR, n = 36; USC, n = 30) treated between January 1 1983 and May 31st, 2008. Data were retrospectively retrieved including demographics, surgical procedures, pathologic data, as well as current disease status from charts, referring physicians' correspondence and tumor registry records.
The median age at diagnosis was 39 years, with a range of 23 to 75 years of age. Stage distribution was as follows: 52 patients FIGO stage IA1; 14 patients FIGO stage IA2 cancers. Lymphovascular space invasion (LVSI) was noted in only 3 cases all of whom were stage IA1.
Patients with stage IA1 were treated with cold knife conization (CKC, n = 7), simple hysterectomy (SH, n = 16), and radical hysterectomy (RH, n = 29). The eleven patients with stage IA2 were treated with CKC (n = 1), SH (n = 2), RH (n = 9), and radical vaginal trachelectomy (RVT, n = 2). Thus, 29 patients with stage IA1 (56%) and 11 patients with stage IA2 (79%) underwent radical surgery. There was no evidence of parametrial involvement in these 40 patients [95% CI: 0–8.8%].
Overall, 34 of the 52 patients with stage IA1 (65%) underwent pelvic lymphadenectomy (LND). Twelve of the fourteen patients with stage IA2 (86%) had LND performed. Of the 46 patients who underwent pelvic lymphadenectomy, one lymph node micrometastasis was noted in a patient with stage IA1 disease with no LVSI. The patient declined adjuvant therapy and remains without any evidence of disease with ≥60 months follow-up. This represents 1.5% of the total cohort and 2.2% of those patients who underwent complete LND.
No recurrences were noted in any of the 66 patients with a median follow up of 80 months (range 4 months to 21.3 years) [95% CI for recurrence was 0–5.5%].
This study represents the largest series of patients with MIAC reported since the current FIGO staging criteria was introduced in 1995. MIAC lesions continue to be treated aggressively due to the assumption that the natural history of adenocarcinoma lesions differs from their squamous counterparts and carry a worse prognosis. However, both in this series and in our larger review of the available literature, MIAC lesions have low rates of lymph node metastases, occult parametrial involvement, or recurrence. It appears that conservative management should be considered in patients with IA1 and IA2 MIAC.