미세 침윤 자궁경부암의 임상 병리학적 분석

Abstract

The diagnosis and management of microinvasive cervical cancer remains a controversial subject. Most authorities define microinvasion by depth of penetration by cancer cells of less than an arbitrarily and subjectively determined 1 or 3 or 5 or more millimeters beneath the basement membrance. Recently, the International Federation of Obstetrics and Gynecology(FIGO) has developed a new cervical cancer staging. We used the definition as stromal invasion of cancer cell with maximum depth of 3 mm and no wider than 7 mm from the base of the epithelium. We conducted this retrospective study in order to evaluate the results of therapeutic approaches in patients with microinvasive cervical cancer. We have experienced 55 cases with microinvasive cervical cancer from November 1987 to May 1995. The age of the study subjects ranged from 39 to 71 years with a median of 39 years. Pregnancy was never experienced in 2 cases(3.6%) and the mean parity was 2.7. The most frequent complaint was postcoital bleeding which was shown in 20 cases(32.1%), whereas most cases were revealed incidentally through the routine Pap smear. The corresponding rate of Pap smear to histologic diagnosis was approximately 36.4%. However, corresponding rate within on histologic grade was about 92.8%. As to the reports of colposcopically directed biopsy, 72.7% of cases showed microinvasion. Type I extended hysterectomy was performed in 26 cases and type II extended hysterectomy was done in 7 cases with less than 1mm invasion and 19 cases with greater than 1 mm and no greater than 3 mm stromal invasion. There was no surgery-related deaths in this series and 5 year survival was 100%. In conclusion, we suggest that less radical therapeutic approach for the patients with no greater 3 mm stromal invasion may be beneficial. But further prospective study based on larger numbers of cases with multi-institutional cooperation and designed protocol will be necessary.