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Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix.

Nagura M, Koshiyama M, Matsumura N, Kido A, Baba T, Abiko K, Hamanishi J, Yamaguchi K, Mikami Y, Konishi I - BMC Cancer (2014)

Bottom Line: In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.MRI can be used to detect preinvasive and microinvasive disease before surgery.It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. koshiyamam@nifty.com.

ABSTRACT

Background: Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior.

Methods: We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis.

Results: Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.

Conclusions: MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

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The relationship between the predictive invasion and the final depth of the invasion. a. The relationship between the stromal invasion (with, without and unclear) on the colposcopic selective biopsies and the final depth of the invasion on the surgical specimens. Four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Ultimately, two (50%) of these patients exhibited no stromal invasion and two (50%) exhibited stromal invasion on the surgical specimens. b. The relationship between the stromal invasion (with or without) on MRI and the final depth of the invasion on the surgical specimens. The two groups in which invasion was or was not detected on MRI did not overlap.
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Fig4: The relationship between the predictive invasion and the final depth of the invasion. a. The relationship between the stromal invasion (with, without and unclear) on the colposcopic selective biopsies and the final depth of the invasion on the surgical specimens. Four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Ultimately, two (50%) of these patients exhibited no stromal invasion and two (50%) exhibited stromal invasion on the surgical specimens. b. The relationship between the stromal invasion (with or without) on MRI and the final depth of the invasion on the surgical specimens. The two groups in which invasion was or was not detected on MRI did not overlap.

Mentions: Three (25%) of the 12 patients with PSCC did not exhibit stromal invasion on the colposcopic selective biopsies (Additional file 3: Table S3). However, one of these three patients displayed a depth of invasion of 1.8 mm on the surgical specimens. Five (42%) of the 12 patients with PSCC were found to have stromal invasion on the colposcopic selective biopsies; all of these five patients also demonstrated stromal invasion on the surgical specimens. However, four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion was only 58% (7/12) on the colposcopic selective biopsies (Additional file 3: Table S3). The range of final depth in this category was wide (Figure 4a). As a whole, it was difficult to determine whether PSCC was associated with stromal invasion using the colposcopic selective biopsies.Figure 4


Clinical approaches to treating papillary squamous cell carcinoma of the uterine cervix.

Nagura M, Koshiyama M, Matsumura N, Kido A, Baba T, Abiko K, Hamanishi J, Yamaguchi K, Mikami Y, Konishi I - BMC Cancer (2014)

The relationship between the predictive invasion and the final depth of the invasion. a. The relationship between the stromal invasion (with, without and unclear) on the colposcopic selective biopsies and the final depth of the invasion on the surgical specimens. Four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Ultimately, two (50%) of these patients exhibited no stromal invasion and two (50%) exhibited stromal invasion on the surgical specimens. b. The relationship between the stromal invasion (with or without) on MRI and the final depth of the invasion on the surgical specimens. The two groups in which invasion was or was not detected on MRI did not overlap.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4232646&req=5

Fig4: The relationship between the predictive invasion and the final depth of the invasion. a. The relationship between the stromal invasion (with, without and unclear) on the colposcopic selective biopsies and the final depth of the invasion on the surgical specimens. Four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Ultimately, two (50%) of these patients exhibited no stromal invasion and two (50%) exhibited stromal invasion on the surgical specimens. b. The relationship between the stromal invasion (with or without) on MRI and the final depth of the invasion on the surgical specimens. The two groups in which invasion was or was not detected on MRI did not overlap.
Mentions: Three (25%) of the 12 patients with PSCC did not exhibit stromal invasion on the colposcopic selective biopsies (Additional file 3: Table S3). However, one of these three patients displayed a depth of invasion of 1.8 mm on the surgical specimens. Five (42%) of the 12 patients with PSCC were found to have stromal invasion on the colposcopic selective biopsies; all of these five patients also demonstrated stromal invasion on the surgical specimens. However, four (33%) PSCC cases involving stromal invasion were ambiguous on the colposcopic selective biopsies. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion was only 58% (7/12) on the colposcopic selective biopsies (Additional file 3: Table S3). The range of final depth in this category was wide (Figure 4a). As a whole, it was difficult to determine whether PSCC was associated with stromal invasion using the colposcopic selective biopsies.Figure 4

Bottom Line: In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.MRI can be used to detect preinvasive and microinvasive disease before surgery.It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Kyoto University, Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. koshiyamam@nifty.com.

ABSTRACT

Background: Papillary squamous cell carcinoma (PSCC) of the uterine cervix is difficult to diagnose due to its rarity and limited data regarding its clinical behavior. We attempted to assess the degree of stromal invasion using magnetic resonance imaging (MRI) and evaluate possible treatments for this lesion in view of its clinical behavior.

Methods: We analyzed 28 cases of PSCC diagnosed on the colposcopic selective biopsies. We studied the rate of accuracy of diagnoses of the colposcopic selective biopsies compared with the final diagnoses, and compared the rate of stromal invasion between the MRI and pathological findings while focusing on surgical methods and the clinical prognosis.

Results: Of the 28 patients, only 12 exhibited true PSCC. The other 16 patients were ultimately diagnosed with SCC or adenosquamous carcinoma based on the finding of the surgical specimens and exhibited relatively poor prognoses. Among the 12 true PSCC cases, the rate of diagnostic accuracy of stromal invasion (with or without) was only 58% (7/12) on the colposcopic selective biopsies. However, we were able to predict the presence of stromal invasion (microscopic borderline: approximately 3 mm) before surgery using MRI. None of the 10 patients treated with radical surgery displayed lymph node metastases. In addition, all 12 study patients exhibited no recurrence (mean: 49 months) and survived.

Conclusions: MRI can be used to detect preinvasive and microinvasive disease before surgery. It is possible to select a less invasive surgical method than radical surgery in cases of preinvasive and microinvasive PSCC in view of the indolent clinical behavior of this disease.

Show MeSH
Related in: MedlinePlus