Assessment of the Revised FIGO Definition for Early Invasive Squamous Cervical Cancer
Abstract & Commentary
Synopsis: The FIGO definition of early squamous cervical cancer is generally acceptable in its present form.
Source: Takeshima N, et al. Gynecol Oncol 1999;74: 165-169.
Takeshima and colleagues investigated the value of the International Federation of Obstetrics and Gynecology (FIGO) classification (1995) for early cervical cancer. Clinico-pathological analysis was performed in 402 patients with invasive squamous cervical cancer in whom the depth of stromal invasion was 5 mm or less. The incidence of lymph-node metastasis was 1.2% (1 of 82) in patients with 3 mm or less depth of invasion; the node-positive patient was in stage IA1. The incidence of lymph node metastasis was 6.8% (5 of 73) in patients with 3-5 mm depth of invasion; this increased with increasing horizontal spread from 3.4% for 7 mm or less to 9.1% for more than 7 mm. None of the four patients in this series had metastasis to the parametrial tissues. Of four patients with recurrence, three had a horizontal spread of more than 7 mm, and the remaining patient was in stage IA2. Takeshima et al conclude that the FIGO definition of early squamous cervical cancer is generally acceptable in its present form.
Comment by David M. Gershenson, MD
The definition of microinvasive cervical cancer has undergone several revisions over the past three decades. In 1973, the Society of Gynecologic Oncologists developed a definition for microinvasion of the cervix that included a lesion that invaded the cervical stroma no more than 3 mm and in which there was no vascular/lymphatic involvement present. FIGO changed its definition of stage IA cervical cancer and then refined the definition in 1994. In the new definition, stage IA1 is defined as the following: measured invasion of stroma no greater than 3 mm in depth and no wider than 7 mm. Stage IA2 is defined as the following: measured invasion of stroma greater than 3 mm and no more than 5 mm in depth and no wider than 7 mm. In the present study, one of 72 patients who met the FIGO definition for stage IA1 and who underwent lymphadenectomy had pelvic node metastasis. All were treated with simple hysterectomy. In the entire study, none of the 297 stage IA1 patients recurred. In the United States, the consensus is that the incidence of lymph node metastasis in stage IA1 disease is less than 1%, and the standard treatment is extrafascial hysterectomy (without lymphadenectomy). For young women with stage IA1 disease who have not completed childbearing, even conization is acceptable treatment if the margins are negative and if the patient agrees to close surveillance. Only one patient in this study with stage IA2 disease had a lymph node metastasis, and only one of 33 patients with stage IA2 disease recurred. The standard treatment for stage IA2 disease remains controversial. Some advocate radical surgery, while others believe that extrafascial hysterectomy is adequate treatment. The numbers in this study are too small to make a judgment. We can hopefully resolve the issue of optimal treatment for stage IA2 disease in the near future.
Which of the following is the FIGO definition of stage IA2 cervical cancer?
a. Depth of invasion < 3 mm, width of invasion < 7mm.
b. Depth of invasion < 3 mm, width of invasion > 7 mm.
c. Depth of invasion 3-5 mm, width of invasion < 7 mm.
d. Depth of invasion 3-5 mm, width of invasion > 7 mm.
d. Depth of invasion 3-5 mm, width of invasion > 7 mm
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