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KMID : 0377619960610100783
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Korean Jungang Medical Journal
1996 Volume.61 No. 10 p.783 ~ p.785
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Superficially Invasive Cervical Carcinoma of the Cervix
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Copeland, Larry J.
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Abstract
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The evolution of treatment patterns for various diseases is subject to a number of factors and may demonstrate significant geographic variance. With regard to microinvasive carcinoma of the cervix, it is not surprising that we continue to debate the appropriate treatment since the international definition of microinvasion continues to be the subject of frequent change and considerable controversy. In 1994 the International Federation of Gynecology and Obstetrics(FIGO) again altered the staging for superficially invasive cervical carcinoma(stage IA), deleting the "minimal invasion" category and replacing it with "less than 3 mm". This change seems to be an attempt to satisfy the many clinicians who are focused on the 3 mm cut-off for microinvasion and who are not comfortable with conservative treatment for the 5 mm/7 mm definition. The lack of prospective randomized trials has not inhibited the creation of strong opinions both with regard to the definition for microinvasion and on the most appropriate treatment for this entity.
In general, clinicians in the United States have been reluctant to accept the Europeanbased recommendation that tumor volume be used to predict the biologic aggressiveness of superficially- invasive cervical carcinomas1) . It is my understanding that the reluctance to use tumor volume is based on two issues i) the practical limitations of accurately measuring the three dimensions of a microcarcinoma, and ii) resistance to relinquish the 3 mm depth as the critical measurement. In 1985, FIGO appeared to be sensitive to the technical problem of identifying tumor volume for these tumors, and their 1985 stage IA2 lesion was described as "a preclinical lesion with no more that 5 mm depth of invasion and a horizontal spread not to exceed 7 mm2.
The contemporary technique for processing cone biopsy specimens provides direct measurement of both the depth of invasion and the radial horizontal spread. Despite easy access to the radial horizontal spread, few contemporary US studies provide details of this measurement. Even if the radial horizontal spread is less than 7 mm. there is no assurance that the lesion is symmetrical and the circumferential horizontal spread may be in excess of 7 mm. A gross estimate of limited circumferential spread would be to exclude lesions close to the endocervix that involved more than two quadrants of sections and to also exclude peripheral lesions that involved more than one quadrant of sections. However, these estimates are also subject to inaccuracies secondary to the size of the cervix and the size of the cone biopsy.
It is difficult to draw exacting conclusions from retrospective studies in general. Retros-
The analysis of microinvasive cervical carcinoma is very difficult and not surprisingly continues to be one of great controversy. The clinical data from every report on microinvasive carcinoma of the cervix deserves the most skeptical of analysis if we are to arrive at any useful conclusions.
For the foreseeable future treatment recommendations must be based on conflicting data that is subject to individual biases and preconceived opinions. With current pathologic techniques and the imbedded opinions about treatment preferences, there is little hope for a prospective multi -institutional randomized treatment trial.
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