Stage IA carcinoma of the cervix revisited

To examine some of the controversy that still exists regarding the definition and management of microinvasive or early invasive cervical carcinoma, in particular, the current concepts regarding the definition of these conditions and their inclusion into the staging system for cervical cancer.

A MEDLINE search was used to identify English-language reports of clinical and pathologic information on cervical cancer. Articles published during 1970-1993 were reviewed.

Articles were selected for review if the information published contained data regarding measured depth of invasion, histologic examination of lymph nodes, and lymphatic vascular space status with these tumors.

Results from the studies were pooled to determine the correlation between depth of invasion with the likelihood of nodal disease and recurrence, both with and without lymphatic vascular space involvement. These studies indicated that the likelihood of recurrence and death from cancer, together with the presence of nodal metastasis, appears to be directly related to the depth of tumor invasion. The relative importance of factors such as lymphatic space involvement will likely remain controversial because they may not be independent prognostic factors.

Review of the literature suggests that although no uniform opinion exists as to how these conditions should be described or managed, the evidence indicates that some modifications to the 1985 staging system for cervical cancer could be made to better categorize patients with these conditions and also, perhaps, provide guidelines for management.