Itsukaichi Mina, Kurata Hitoshi, Matsushita Mitsuru, Watanabe Minoru, Sekine Masayuki, Aoki Yoichi, Tanaka Kenichi
Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan.
Gynecol Oncol. 2003 Aug;90(2):387-9. doi: 10.1016/s0090-8258(03)00333-0.
Cone margin status has been reported to be the most important predictor of recurrent disease in patients with cervical intraepithelial neoplasia (CIN) undergoing cervical conization. Our purpose was to evaluate the conservative management of selected patients with microinvasive (FIGO stage Ia1) squamous cell carcinoma who have been treated by cervical conization with positive margins.
Twenty-seven patients underwent KTP laser conization and vaporization for stage Ia1 squamous cell carcinoma followed by careful observation. Involved margins were diagnosed if CIN III or more was present at the ectocervical or endocervical margin and 7 patients formed the basis of the present study. Follow-up consisted of cytology, histology, and pelvic examination. Disease recurrence was defined as a histology diagnosis of CIN III or more on colposcopically directed biopsy or endocervical curettage.
The endocervical margins were involved by carcinoma in situ in seven (26%) patients. No ectocervical margin involvement was detected. No lymph-vascular space involvement (LVSI) and confluent invasion were seen. All seven patients were free of recurrent disease during median follow-up of 4.0 (range 2.3-7.6) years.
These results suggest that laser conization and vaporization may be a reasonable treatment option in patients with microinvasive (FIGO Stage Ia1) squamous cell carcinoma despite positive cone margins without invasive disease when LVSI is not demonstrated.
据报道，对于接受宫颈锥切术的宫颈上皮内瘤变（CIN）患者，切缘状态是疾病复发的最重要预测因素。我们的目的是评估经宫颈锥切术后切缘阳性的部分微浸润（国际妇产科联盟（FIGO）分期Ia1）鳞状细胞癌患者的保守治疗方法。
27例Ia1期鳞状细胞癌患者接受了KTP激光锥切术和汽化术，随后进行密切观察。如果宫颈外口或宫颈管切缘存在CIN III或更高程度病变，则诊断为切缘受累，本研究以7例患者为基础。随访包括细胞学检查、组织学检查和盆腔检查。疾病复发定义为在阴道镜引导下活检或宫颈管刮除术中组织学诊断为CIN III或更高程度病变。
7例（26%）患者的宫颈管切缘有原位癌累及。未检测到宫颈外口切缘受累。未见淋巴血管间隙浸润（LVSI）和融合性浸润。在中位随访4.0年（范围2.3 - 7.6年）期间，所有7例患者均无疾病复发。
这些结果表明，对于微浸润（FIGO Ia1期）鳞状细胞癌患者，尽管锥切切缘阳性且无浸润性疾病，但未显示LVSI时，激光锥切术和汽化术可能是一种合理的治疗选择。
