Loop Electrosurgical Excision Procedure Findings for Identification of Patients With Early-Stage Cervical Cancer Suitable for Less Radical Surgery

2012 ◽  
Vol 22 (7) ◽  
pp. 1214-1219 ◽  
Author(s):  
Mi-Kyung Kim ◽  
Min A Kim ◽  
Jae Weon Kim ◽  
Hyun Hoon Chung ◽  
Noh-Hyun Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Subgroup Analysis ◽  
Resection Margin ◽  
Early Stage ◽  
Low Risk ◽  
Depth Of Invasion ◽  
Parametrial Invasion ◽  
Early Stage Cervical Cancer ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

ObjectiveTo define a subset of patients with early-stage cervical cancer at low risk for parametrial invasion through pathologic parameters of loop electrosurgical excision procedure (LEEP).Materials and MethodsA retrospective analysis of data from 131 patients who underwent LEEP before radical hysterectomy or radical trachelectomy for stage IA2 to IB1 cervical cancer was performed. Subgroup analysis was performed to define a group of patients at the lowest risk for parametrial invasion based on LEEP findings.ResultsOverall, 7 (5.3%) of 131 patients showed parametrial involvement, all of whom had residual tumors in hysterectomy specimens. Risk factors for residual disease included a tumor width greater than 30 mm and a positive endocervical or deep resection margin. A subgroup analysis demonstrated that LEEP parameters, including a depth of invasion of 5 mm or less and a negative endocervical resection margin, were able to define the subgroup of patients at low risk for parametrial invasion. In 24 patients (18.3%) who met these criteria, there was no evidence of parametrial spread as well as nodal metastasis.ConclusionA subgroup of patients with early-stage cervical cancer selected by the 2 LEEP variables, depth of invasion of 5 mm or less and a negative endocervical resection margin, demonstrated no risk for parametrial invasion.

Identification of a patient group at low risk for parametrial invasion in early-stage cervical cancer

2010 ◽  
Vol 119 (3) ◽  
pp. 426-430 ◽  
Author(s):  
Dae-Chul Jung ◽  
Mi-Kyung Kim ◽  
Sokbom Kang ◽  
Sang-Soo Seo ◽  
Jeong Yeon Cho ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Patient Group ◽  
Early Stage ◽  
Low Risk ◽  
Parametrial Invasion ◽  
Early Stage Cervical Cancer

Clinical Stage I Carcinoma of the Uterine Cervix Value of Preoperative Magnetic Resonance Imaging in Assessing Parametrial Invasion

2002 ◽  
Vol 88 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Sandro Sironi ◽  
Massimo Bellomi ◽  
Gaetano Villa ◽  
Silvia Rossi ◽  
Alessandro Del Maschio
Keyword(s):  
Cervical Cancer ◽  
Mr Imaging ◽  
Tumor Invasion ◽  
Early Stage ◽  
Imaging Techniques ◽  
Clinical Stage ◽  
Fast Spin Echo ◽  
Parametrial Invasion ◽  
Early Stage Cervical Cancer ◽  
T2 Weighted Images

Aims and Background The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer. Methods A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference. Results In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging. Conclusions Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.

Utilization and outcomes of adjuvant systemic chemotherapy alone in high risk, early stage cervical cancer in the United States

2021 ◽  
pp. ijgc-2021-002655
Author(s):  
Koji Matsuo ◽  
David J Nusbaum ◽  
Shinya Matsuzaki ◽  
Maximilian Klar ◽  
Muneaki Shimada ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Systemic Chemotherapy ◽  
Early Stage ◽  
External Beam Radiotherapy ◽  
The United States ◽  
Nodal Metastasis ◽  
External Beam ◽  
Parametrial Invasion ◽  
Early Stage Cervical Cancer

ObjectiveTo examine trends and outcomes related to adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer.MethodsThis retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000 to 2016. Surgically treated women with American Joint Commission on Cancer stages T1–2 cervical cancer who had high risk factors (nodal metastasis and/or parametrial invasion) and received additional therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for systemic chemotherapy versus external beam radiotherapy with chemotherapy.ResultsAmong 2462 patients with high risk factors, 185 (7.5%) received systemic chemotherapy without external beam radiotherapy, of which the utilization significantly increased over time in multivariable analysis (adjusted odds ratio per 1 year increment 1.06, 95% confidence interval (CI) 1.02 to 1.09). In weighted models, adjuvant chemotherapy and combination therapy (external beam radiotherapy and chemotherapy) had comparable overall survival among patients aged <40 years (hazard ratio (HR) 0.73, 95% CI 0.41 to 1.33), in adenocarcinoma or adenosquamous histologies (HR 0.90, 95% CI 0.62 to 1.32), and in those with nodal metastasis alone without parametrial tumor invasion (HR 1.17, 95% CI 0.84 to 1.62). In contrast, systemic chemotherapy alone was associated with increased all cause mortality compared with combination therapy in patients aged ≥40 years (HR 1.57, 95% CI 1.19 to 2.06), with squamous histology (HR 1.63, 95% CI 1.19 to 2.22), and with parametrial invasion alone (HR 1.87, 95% CI 1.09 to 3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95% CI 1.06 to 2.52).ConclusionUtilization of adjuvant systemic chemotherapy alone for high risk, early stage cervical cancer is increasing in the United States in the recent years. Our study suggests that survival effects of adjuvant systemic chemotherapy may vary based on patient and tumor factors. External beam radiotherapy with chemotherapy remains the standard for high risk, early stage cervical cancer, and use of adjuvant systemic chemotherapy without external beam radiotherapy should be considered with caution.

Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care?

2020 ◽  
Vol 30 (7) ◽  
pp. 981-986 ◽  
Author(s):  
Marie Plante ◽  
Marie-Claude Renaud ◽  
Alexandra Sebastianelli ◽  
Jean Gregoire
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Residual Disease ◽  
Early Stage ◽  
Low Risk ◽  
Gadolinium Contrast ◽  
Pelvic Mri ◽  
Pelvic Node Dissection ◽  
Early Stage Cervical Cancer ◽  
Lymph Node Assessment

ObjectiveThere is a trend toward less radical surgery in women with small-volume disease who wish to preserve fertility. The objective of our study was to evaluate the oncologic and obstetrical outcome of simple vaginal trachelectomy and lymph node assessment in patients with low-risk early-stage cervical cancer (<2 cm).MethodsFrom May 2007 to January 2020, 50 patients underwent a simple vaginal trachelectomy/conization with laparoscopic sentinel lymph node mapping±complete pelvic node dissection. Patients underwent loop electrocautery excision (LEEP), cone/cervical biopsies, or simple trachelectomy. A preoperative pelvic MRI with gadolinium contrast was systematically performed in all cases. The size of the lesion was established by review of the LEEP, cone or trachelectomy specimen, MRI, and clinical examination. Data was collected prospectively in a computerized database. Descriptive statistics and the Kaplan–Meier estimate were used for analysis.ResultsThe median age was 29 years (range: 21–44) and 35 (70%) patients were nulliparous. As per FIGO 2009 classification, 11 patients had stage IA1 with lymphovascular space invasion (LVSI), 13 patients had stage IA2, and 26 patients had stage IB1. Twenty-six patients had squamous histology, 20 patients adenocarcinoma, and four patients other histologies. On final pathology, lymph nodes were negative in 46 patients (92%), three patients had isolated tumor cells, and one patient had micrometastasis. Thirty patients (60%) had either no residual disease in the trachelectomy specimen (22) or residual dysplasia only (eight). With a median follow-up of 76 months (range: 1–140), only one local recurrence occurred which was treated initially with chemoradiation. She recurred again locally and underwent a pelvic exenteration: the patient progressed again and died of disease. The 5-year progression-free survival and overall survival was 97.9% and 97.6%, respectively. There were 40 pregnancies: five (12.5%) ended in the first trimester, one (2.5%) in the second trimester, and three (7.5%) were late preterm: all the others (30 or 75%) delivered >36 weeks and one pregnancy is ongoing.ConclusionSimple trachelectomy/conization and lymph node assessment is an oncologically safe fertility-preserving surgery in well-selected patients with low-risk early-stage cervical cancer (<2 cm). Obstetrical outcomes are comparable to the general population.

scholarly journals Routine Intraoperative Frozen Section Examination to Minimize Bimodal Treatment in Early-Stage Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1148-1153 ◽  
Author(s):  
Phanedra K. Gubbala ◽  
Alexandros Laios ◽  
Zhe Wang ◽  
Sunanda Dhar ◽  
Pubudu J. Pathiraja ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Frozen Section ◽  
Gynecological Cancer ◽  
False Negative ◽  
Low Risk ◽  
Nodal Disease ◽  
Intraoperative Frozen Section ◽  
Frozen Section Examination ◽  
Early Stage Cervical Cancer

ObjectiveIn early-stage cervical cancer, single modality therapy is the main objective, to minimize patient morbidity while offering equivalent cure rates. Intraoperative frozen section examination (FSE) of lymph nodes (LNs) can facilitate this aim, ensuring that radical surgery is avoided in patients requiring adjuvant therapy for metastatic LN involvement. We aimed to evaluate the accuracy of routine intraoperative FSE of pelvic LNs during the surgical staging of early-stage cervical cancers and identify a group at low risk for nodal metastases.MethodsA retrospective cohort study of 94 women aged 23 to 80 years who underwent primary surgery and planned intraoperative FSE of the pelvic LNs at the gynecological cancer center in Oxford was performed. The diagnostic value of FSE and the prediction of metastatic nodal disease were assessed by use of preoperative and intraoperative variables.ResultsA total of 1825 LNs were submitted for FSE. Of 94 women (13.8%), 13 had positive LNs at FSE. Two false-negative cases were reported with micrometastases but no false-positive cases. Frozen section examination as a diagnostic test reached a sensitivity of 86.7% and a specificity of 100%. A regression model including grade I to II and tumor size of less than 20 mm identified a low-risk group for LN involvement.ConclusionsIn light of diverse practice patterns, FSE should be routinely offered to women with early-stage cervical cancer in a 1-step protocol. We equally devised a model to predict those patients at least risk of nodal disease, who may be spared of FSE.

Utilization and outcome of systemic chemotherapy for high-risk early-stage cervical cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17521-e17521
Author(s):  
Munetaka Takekuma ◽  
Shinya Matsuzaki ◽  
Koji Matsuo
Keyword(s):  
Cervical Cancer ◽  
High Risk ◽  
Systemic Chemotherapy ◽  
Risk Group ◽  
Early Stage ◽  
Nodal Metastasis ◽  
High Risk Group ◽  
Parametrial Invasion ◽  
All Cause Mortality ◽  
Early Stage Cervical Cancer

e17521 Background: To examine trends and outcomes of systemic chemotherapy for high-risk early-stage cervical cancer. Methods: This retrospective observational study queried the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program from 2000-2016. Surgically-treated women with stage T1-2 cervical cancer who had high-risk factors (lymph node metastasis and/or parametrial invasion) and received adjuvant therapy were examined. Propensity score inverse probability of treatment weighting was used to assess the survival estimates for chemotherapy use versus external beam with chemotherapy (CCRT). Results: Among 2, 462 women with high-risk factor, 185 (7.5%) received systemic chemotherapy. Utilization of chemotherapy has significantly increased over time in multivariable analysis (adjusted-odds ratio per 1-year increment, 1.06, 95% confidence interval [CI] 1.02-1.09). In weighted models, adjuvant chemotherapy and CCRT had comparable survival among women aged < 40 (hazard ratio [HR] for all-cause mortality 0.73, 95%CI 0.41-1.33), adenocarcinoma or adenosquamous histologies (HR 0.90, 95%CI 0.62-1.32), and high-risk group based on nodal metastasis alone (HR 1.17, 95%CI 0.84-1.62). In contrast, chemotherapy was associated with increased all-cause mortality compared to CCRT among women aged ≥40 (HR 1.57, 95%CI 1.19-2.06), squamous histology (HR 1.63, 95%CI 1.19-2.22), and high-risk group per parametrial invasion alone (HR 1.87, 95%CI 1.09-3.20) or parametrial invasion with nodal metastasis (HR 1.64, 95%CI 1.06-2.52). Conclusions: Utilization of systemic chemotherapy for high-risk early-stage cervical cancer is increasing in the United States. Survival effects of adjuvant chemotherapy varied per patient and tumor factors, and this indication may be limited to those who are < 40 years with non-squamous histology and absence of parametrial invasion.

scholarly journals Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

2014 ◽  
Vol 132 (1) ◽  
pp. 254-259 ◽  
Author(s):  
Pedro T. Ramirez ◽  
Rene Pareja ◽  
Gabriel J. Rendón ◽  
Carlos Millan ◽  
Michael Frumovitz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Surgery ◽  
Early Stage ◽  
Standard Of Care ◽  
Low Risk ◽  
Early Stage Cervical Cancer
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