Sun Li, Zhang Wen-Hua, Li Shu-Min, Wu Ling-Ying, Bai Ping, Zhang Xun, Li Ling
Department of Gynecological Oncology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, PR China.
Ai Zheng. 2004 Feb;23(2):204-6.
BACKGROUND & OBJECTIVE: The preoperative diagnosis and management of stage IA(1) squamous carcinoma of the cervix remains a controversial subject. The aim of this study was to discuss diagnosis and appropriate management options of this disease.
Clinical data and pathological materials of 30 patients with stage IA(1) squamous carcinoma of the cervix, who were treated in Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College between 1992 to 2001, were reviewed.
Seven of 30 patients (23.3%) had neither specific symptoms nor signs. Twenty-three patients had cytological examination with the positive rate of 86.9% (20/23). Colposcopy was performed in 23 of the women; the accuracy of colposcopical impression was 78.2%(18/23). Of 10 endocervical curettage (ECC) specimens, 4 cases had abnormal pathology. Among 30 patients, 22 (73.3%) were treated with radical hysterectomy, 6 with simple hysterectomy, and 2 with cold conization only. There was no parametrical involvement and no positive vaginal margin in any of 28 patients who had hysterectomy. Lymphadenectomy was performed in 8 cases; the mean number of lymph nodes removed was 22, and no metastasis was found. The two conization specimens had free surgical margin. The preoperative diagnosis agreed with final diagnosis in only 56.7% (17/30); there was statistically significant difference between them (P< 0.01). During median 34 months follow-up (range, 17-111 months), no developed recurrences and no died from cancer.
The diagnostic accuracy of colposcopically directed biopsy is quite poor for stage IA(1) cervical carcinoma. Cervical cold conization may increase the diagnostic accuracy and may be recommended for patients who desire conservation of fertility.
宫颈IA（1）期鳞状细胞癌的术前诊断与处理仍是一个存在争议的话题。本研究旨在探讨该疾病的诊断及合适的处理方案。
回顾了1992年至2001年在中国医学科学院肿瘤医院、北京协和医学院接受治疗的30例宫颈IA（1）期鳞状细胞癌患者的临床资料和病理材料。
30例患者中有7例（23.3%）既无特异性症状也无体征。23例患者进行了细胞学检查，阳性率为86.9%（20/23）。23名女性接受了阴道镜检查，阴道镜印象的准确率为78.2%（18/23）。10例宫颈管刮术（ECC）标本中，4例病理异常。30例患者中，22例（73.3%）接受了根治性子宫切除术，6例接受了单纯子宫切除术，2例仅接受了冷刀锥切术。28例行子宫切除术的患者均未发现宫旁浸润及阴道切缘阳性。8例行淋巴结切除术，平均切除淋巴结数为22个，未发现转移。2例锥切标本手术切缘阴性。术前诊断与最终诊断仅在56.7%（17/30）的患者中相符，两者之间存在统计学显著差异（P<0.01）。在中位34个月的随访期（范围17 - 111个月）内，无复发发生，也无患者死于癌症。
对于宫颈IA（1）期癌，阴道镜引导下活检的诊断准确性较差。宫颈冷刀锥切术可提高诊断准确性，对于希望保留生育功能的患者可考虑推荐。
