Pathologic Findings From Conization as Predictors of Residual Disease in Stage IA2 Cervical Cancer: Implications for Fertility-Preserving Surgery With Sentinel Lymph Node Biopsy

TL;DR

This study shows that conization with sentinel lymph node biopsy can be a safe fertility-preserving treatment for some stage IA2 cervical cancer patients, especially those with squamous cell carcinoma and negative tests.

Contribution

Identifies specific pathologic predictors of residual disease in stage IA2 cervical cancer to guide fertility-preserving surgery.

Findings

Positive endocervical curettage was significantly associated with residual tumor in final hysterectomy specimens.

No residual tumor was found in patients with both negative endocervical curettage and negative endocervical margins.

All patients who underwent trachelectomy preserved fertility potential with no recurrences during 45 months of follow-up.

Abstract

Introduction: Conization is a standard fertility-preserving treatment for stage IA1 cervical cancer; however, its role in stage IA2 disease remains controversial due to limited supporting evidence. This study aimed to evaluate the feasibility of conization with or without sentinel lymph node (SLN) biopsy as a fertility-sparing strategy in patients with stage IA2 cervical cancer.

Methods: We retrospectively analyzed 20 patients diagnosed with stage IA2 cervical cancer based on conization pathology who subsequently underwent modified radical or radical hysterectomy or trachelectomy with SLN biopsy at Kagoshima University Hospital between March 2014 and December 2023. SLN mapping was performed using a hybrid technique combining technetium-99m and indocyanine green. Residual tumor presence in hysterectomy specimens and associated clinicopathologic factors were evaluated.

Results: The median age was 45 years. Histologic subtypes included squamous cell carcinoma (75%) and adenocarcinoma (25%). SLN mapping was successfully performed bilaterally in all patients (100%), with no SLN metastases detected. Residual tumor was identified in eight patients (40%). Positive endocervical curettage (ECC) was significantly associated with residual tumor (OR = 3.38, 95% CI: 1.31-8.76, p = 0.035). Notably, no residual tumor was observed in patients with both negative ECC and negative endocervical margins. Among the five patients who underwent trachelectomy, all preserved their fertility potential during the follow-up period, and no recurrences were observed during a median follow-up of 45 months.

Conclusion: In patients with stage IA2 cervical cancer, positive ECC and adenocarcinoma histology were significantly associated with residual tumor in the final hysterectomy specimen. Importantly, no residual tumor was observed in patients with both negative ECC and negative endocervical margin, particularly among those with squamous cell carcinoma. These findings suggest that for highly selected patients, especially those with squamous histology, conization ± SLN biopsy may represent a safe and less invasive fertility-preserving alternative to trachelectomy. Further prospective studies are needed to confirm oncologic safety and define appropriate selection criteria, particularly for cases of adenocarcinoma.