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Do all patients with invasive cervical carcinoma need a radical hysterectomy?; Stage IA – can only be diagnosed microscopically IA1 ≤ 3 mm invasion; extension no wider than 7 mm IA2 3 mm - 5 mm; extension no wider than 7 mm; Cold-knife or loop excision? Mx of microinvasive squamous disease Mx of microadenocarcinoma MX of small volume early invasive disease;Issues (1); Both cheap Both LA / GA Margins are the critical factor When any suggestion of cancer/lesion out of range…cold knife best;Pregnancy Outcomes and Loop excision/Cone;Issues (2);Specimen ProcessingCritical;Multiple comparisons of management of CIN111No studies comparing management of microinvasive carcinoma; Cone adequate no matter age ;Micro-invasive Carcinoma Cervix.. Node Positivity (Ostor,1998);FIGO Biannual Report2006;;1-3 mm risk of nodes +ve ~0.5% 3-5 mm risk of nodes +ve ~3.4% LVS +ve ~ doubles LN risk;Micro-invasive SquamousDisease Management;Conclusions;Rationale for the existence of microadenocarcinoma;Microadenocarcinoma Endocervical Villoglandular Intestinal Endometrioid Clear Cell Adenosquamous;30 years old;Would you?; Invasion 5 mm or less, complete obliteration of normal endocervical crypts, extension beyond normal glandular field, stromal response. 126/436 – rad hyst – no parametrial involvement 155 cases – no adnexal involvement 5/219 cases – +ve Nodes (2%) 15 recurrences 6 deaths from disease; n = 20 IA 2 x simple; 14 x radical hyst; 4 conization No recurrence ACIS ? n = 42 ? n = 20 conization No recurrence in conization cases; median follow-up 48 months (UC Irvine); SEER data 200 IA1; 286 IA2 Simple hyst 48.6%; rad hyst 37.5% 1.5% +ve LN (n = 197) Survival 98.5%; 98.6% (Alberquerque); 585 IA1; 358 IA2 531 lymphadenectomies – 1.3% +ve No significant difference in nodal positivity or survival vs stage