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1、Doallpatientswithinvasivecervicalcarcinomaneedaradicalhysterectomy?LeuvenMay2007StageIA–canonlybediagnosedmicroscopicallyIA1≤<3mminvasion;extensionnowiderthan7mmIA2>3mm-5mm;extensionnowiderthan7mmMicroinvasiveCarcinoma oftheCervixFIGO,1995Cold-knifeor
2、loopexcision?MxofmicroinvasivesquamousdiseaseMxofmicroadenocarcinomaMXofsmallvolumeearlyinvasivediseaseControversialAreasIssues(1)HistologicalsubtypeTypeofcone….coldknife/laser/LeepTissuepreparation..method/numberofsectionsMarginStatusLVSIBothcheapBot
3、hLA/GAMarginsarethecriticalfactorWhenanysuggestionofcancer/lesionoutofrange…coldknifebestColdKnifeor LoopExcision?PregnancyOutcomesandLoopexcision/ConeSadler,NZ,2004,JAMA…increasedPRMwithLoopKyrgiou,2006,Lancet…RR2.59coneandprematurity,1.7Loop.LaserOK
4、(=RWHdata)Bruinsmaetal,2007…bothtreatedanduntreatedwomenhaveincreasedriskofprematurityIssues(2)RiskofparametrialspreadRiskofadnexalspreadRiskofnodalspreadWhattodoafterchildbirthSummaryrecommendationsSpecimenProcessing CriticalRadialSagittalWholespecim
5、enStepsectionofnodesSpecialstainsMultiplecomparisonsofmanagementofCIN111 NostudiescomparingmanagementofmicroinvasivecarcinomaConeadequatenomatterageEarlyStromalInvasionMicro-invasiveCarcinoma Cervix..NodePositivity(Ostor,1998)FIGOBiannualReport 200696
6、8CasesIa1,3841a292%Ia1treatedbysurgery,65%Ia2n=402with<5mminvasionLN+ve,1.2%if3mmorlessinvasion 6.8%if>3–5mminvasion4recurrences,3ofwhomhad>7mm horizontalspread(Tokyo)MicroinvasiveCarcinoma oftheCervixTakeshimaetal,19991-3mmriskofnodes+ve~0.5%3-5mmris
7、kofnodes+ve~3.4%LVS+ve~doublesLNriskMicroinvasiveDiseaseMicro-invasiveSquamous DiseaseManagement1-3mm…..treatasifESI,unlessLVS+ve.ConsiderHystiffertilitycomplete3-5mm…simplehystandnodes/coneandnodesiffertilityanissueConclusionsMeticulous,accuratepatho
8、logyessential.Treatmentbyconealoneissafetreatmentinstage1a1withoutLVSI.Theroleofconealoneinstage1a2needsfurtherstudy(cf,radtrachelectomy/amputation)Roleoflymphnodedissectionneedsfurtherassessment.Evaluationoftheplaceofsentinelnodedetectionisne
