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Sensitivity of Follow-Up Methods in Patients After Fertility-Sparing Surgery for Cervical Cancers
  1. Jiri Slama, MD, PhD,
  2. Daniela Fischerova, MD, PhD,
  3. Michal Zikan, MD, PhD,
  4. Roman Kocian, MD,
  5. Anna Germanova, MD, PhD,
  6. Filip Fruhauf, MD,
  7. Ladislav Dusek, PhD and
  8. David Cibula, MD, PhD
  1. * 1st Faculty of Medicine, Department of Gynecology and Obstetrics, Gynecologic Oncology Centre, Charles University and General University Hospital in Prague; and
  2. Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
  1. Address correspondence and reprint requests to Jiri Slama, MD, PhD, 1st Faculty of Medicine, Gynecologic Oncology Centre, Charles University and General University Hospital in Prague, Apolinarska 18, 128 51 Prague 2, Czech Republic. E-mail: Jiri.Slama{at}vfn.cz.

Abstract

Objective The aim of our study was to compare the sensitivity of various methods and their combinations in the follow-up of patients with cervical cancer after fertility-sparing surgery (FSS).

Methods Included were women with cervical cancer in stages IA2 to IB2 who underwent FSS, which includes pelvic lymphadenectomy, sentinel lymph node biopsy, abdominal radical trachelectomy, vaginal trachelectomy, or needle conization. Follow-up visits were scheduled at 3-month intervals and included symptom-oriented discussion, gynecological and physical examination, colposcopy, Papanicolaou test, human papillomavirus (HPV) DNA test, and ultrasound examination. All cases with a recurrent disease were thoroughly analyzed, and the results of individual examinations were compared.

Results In total, 43 women (IA2, 8; IB1, 33; IB2, 2) were enrolled. The mean patient age was 31 years; most patients were nulliparous (68.4%, 26/38) with squamous cell cancers (26/38). Abdominal radical trachelectomy was performed in 10 women, simple vaginal trachelectomy was performed in 11 women, and conization was performed in 22 women, according to the tumor characteristics and topography. The median duration of the follow-up reached 37 months. Invasive cancer and high- and low-grade squamous intraepithelial lesions were detected in 8, 1, and 1 patients, respectively. All except 1 event were central, detected within the first year after FSS. Only 2 cases were symptomatic. Colposcopy detected 7 of 10 recurrences; 5 of them were HPV positive, and, in 2 cases, a Papanicolaou test revealed abnormalities. Papanicolaou tests were false positive in 27.7%, especially after trachelectomies.

Conclusions Most patients in whom cancer recurred after FSS reveal central or pelvic lesions, which can be successfully treated with salvage surgery or radiotherapy. The early detection of recurrence is an essential condition for a favorable oncological outcome. Colposcopy alone and in combination with HPV positivity showed the highest sensitivity for the detection of recurrent diseases, whereas other methods had limited reliability.

  • Fertility-sparing surgery
  • Cervical cancer
  • Recurrence

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Footnotes

  • The authors declare no conflicts of interest.

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