Laser CO(2) conization: a safe mode of treating conservatively microinvasive carcinoma of the uterine cervix.

Objective: To evaluate the outcome of conservative treatment by laser CO(2) conization, for the management of microinvasive carcinoma of the uterine cervix (MIC).

Study Design: From 1990 to 1999, 90 women with the diagnosis of MIC were treated in the Gynecological Oncology Unit of "Alexandra" Hospital. Final diagnosis of MIC was based on cervical conization as well as simple and radical hysterectomy specimens. The cytological and colposcopical diagnoses prior to conization were reviewed. The cone specimen parameters examined by the pathologists were depth and width of invasion, lymph-vascular space invasion (LVSI) and surgical margins status. The modality used for all conizations, either primary or secondary, was the laser CO(2) under local anaesthesia.

Results: Diagnosis of MIC was made on cone biopsy in 73 women (81%), in simple hysterectomy in 10 (11%) and in radical hysterectomy specimens in 7 (8%). From the patients that underwent conization, two (2.5%) were detected with LVSI. Five patients (7%) were found to have involved margins and from those, the majority was managed by a second conization. Mean follow-up time was 54 months (range: 30-110 months). Four patients (6.6%) with recurrence were observed during follow-up, all of them with LSIL. No cases of invasive disease or HSIL were encountered.

Conclusions: Laser CO(2) conization is a safe and effective mode of treatment for women suffering from MIC and wish to retain their fertility. However, this type of management should be advocated only in cases fulfilling the strict criteria for MIC as these have been defined by FIGO.