Wang Tong, Wu Yu-mei, Song Fang, Zhu Li, Hao Xia, Kong Wei-min, Duan Wei, Fan Ling, Zhang Wei-yuan
Department of Gynecologic Oncology, Beijing Obstetric and Gynecologic Hospital, Capital Medical University, Beijing 100006, China.
Zhonghua Fu Chan Ke Za Zhi. 2012 Dec;47(12):888-92.
To evaluate the maternal and fetal outcomes of planned delay in treatment for cervical microinvasive squamous cancer during pregnancy.
A prospective study of pregnant women was done from August 1, 2007 to May 31, 2010. Pregnant women who had not been carried out cervical cytological screening within one year were got thin-prep cytology test (TCT) screening at their initial prenatal visit. Patients with abnormal cytological results were performed colposcopic examination and directed biopsy. Women with cervical microinvasive cancer were followed up every 8 to 12 weeks. If lesion progression were suspected, compared with previous image, repeated biopsy directed by colposcopy should be performed. Once worsening invasive cancer was confirmed, the pregnancy should be terminated timely. All patients should be reevaluated 6 to 12 weeks postpartum with repeated colposcopic examination and biopsy. All mothers were performed cold knife conization (CKC) at 6 to 12 weeks postpartum.
We totally diagnosed 17 cases cervical microinvasive squamous carcinoma during pregnancy. The positive rate is 6.2/10 000 (17/27 230). After informed consent, 15 pregnant women decided to delay treatment until fetal maturation. The mean gestational age of initial diagnosis was (19.3 ± 5.9) weeks. The women were followed up 2 to 4 times during pregnancy. Only 1 patient was verified lesion progression by directed biopsy at 34 weeks and delivered by cesarean section. The progression rate during pregnancy was 1/15. The mean delivered time was (37.1 ± 1.8) weeks (ranged from 34 to 40 weeks). The mean diagnosis-to-delivery interval was (18.4 ± 5.2) weeks. All patients were delivered by cesarean section and all newborns had good outcomes. Finally we confirmed 1 case with cervical cancer stage Ia2, 11 cases with stage Ia1, 3 cases with cervical intraepithelial neoplasia (CIN) III by pathological diagnosis after CKC during 6 to 12 weeks postpartum. All cases were disease free after follow-up ranged from 22 to 48 months.
It is necessary to perform TCT screening for pregnant women who have not been carried out cervical cytology screening within 1 year. If cervical microinvasive squamous cancer were suspected during pregnancy, in order to achieve fetal maturity it is acceptable for the women who desired pregnancy to delay treatment under closely monitoring until postpartum.
评估孕期宫颈微浸润性鳞状细胞癌计划性延迟治疗的母婴结局。
对2007年8月1日至2010年5月31日的孕妇进行前瞻性研究。在初次产前检查时，对一年内未进行宫颈细胞学筛查的孕妇进行薄层液基细胞学检测（TCT）筛查。细胞学结果异常的患者进行阴道镜检查及定向活检。宫颈微浸润癌患者每8至12周进行一次随访。若怀疑病变进展，与之前的影像相比，应在阴道镜引导下重复活检。一旦确诊为浸润性癌恶化，应及时终止妊娠。所有患者产后6至12周应进行复查，重复阴道镜检查及活检。所有产妇在产后6至12周进行冷刀锥切术（CKC）。
共诊断出17例孕期宫颈微浸润性鳞状细胞癌。阳性率为6.2/10000（17/27230）。在获得知情同意后，15名孕妇决定延迟治疗至胎儿成熟。初次诊断时的平均孕周为（19.3±5.9）周。孕期对这些孕妇进行了2至4次随访。仅1例患者在34周时经定向活检证实病变进展，行剖宫产分娩。孕期进展率为1/15。平均分娩时间为（37.1±1.8）周（范围为34至40周）。诊断至分娩的平均间隔时间为（18.4±5.2）周。所有患者均行剖宫产分娩，所有新生儿结局良好。产后6至12周行CKC后，经病理诊断最终确诊1例宫颈癌Ia2期，11例Ia1期，3例宫颈上皮内瘤变（CIN）III级。随访22至48个月后，所有病例均无疾病复发。
对一年内未进行宫颈细胞学筛查的孕妇进行TCT筛查很有必要。若孕期怀疑宫颈微浸润性鳞状细胞癌，为实现胎儿成熟，对于期望继续妊娠的女性，在密切监测下延迟治疗至产后是可以接受的。
