Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy
Identifieur interne : 004B19 ( Istex/Corpus ); précédent : 004B18; suivant : 004B20Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy
Auteurs : Joseph L. Kelley Iii ; Thomas W. Burke ; Carmen Tornos ; Mitchell Morris ; David M. Gershenson ; Elvio G. Silva ; J. Taylor WhartonSource :
- Gynecologic Oncology [ 0090-8258 ] ; 1992.
Abstract
It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma in situ. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.
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DOI: 10.1016/0090-8258(92)90050-S
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Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Tornos, Carmen" sort="Tornos, Carmen" uniqKey="Tornos C" first="Carmen" last="Tornos">Carmen Tornos</name><affiliation><mods:affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Morris, Mitchell" sort="Morris, Mitchell" uniqKey="Morris M" first="Mitchell" last="Morris">Mitchell Morris</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Gershenson, David M" sort="Gershenson, David M" uniqKey="Gershenson D" first="David M." last="Gershenson">David M. Gershenson</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Silva, Elvio G" sort="Silva, Elvio G" uniqKey="Silva E" first="Elvio G." last="Silva">Elvio G. Silva</name><affiliation><mods:affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Wharton, J Taylor" sort="Wharton, J Taylor" uniqKey="Wharton J" first="J. Taylor" last="Wharton">J. Taylor Wharton</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. 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Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Burke, Thomas W" sort="Burke, Thomas W" uniqKey="Burke T" first="Thomas W." last="Burke">Thomas W. Burke</name><affiliation><mods:affiliation>To whom correspondence should be addressed at Department of Gynecology, Box 67, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Tornos, Carmen" sort="Tornos, Carmen" uniqKey="Tornos C" first="Carmen" last="Tornos">Carmen Tornos</name><affiliation><mods:affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Morris, Mitchell" sort="Morris, Mitchell" uniqKey="Morris M" first="Mitchell" last="Morris">Mitchell Morris</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Gershenson, David M" sort="Gershenson, David M" uniqKey="Gershenson D" first="David M." last="Gershenson">David M. Gershenson</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Silva, Elvio G" sort="Silva, Elvio G" uniqKey="Silva E" first="Elvio G." last="Silva">Elvio G. Silva</name><affiliation><mods:affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author><author><name sortKey="Wharton, J Taylor" sort="Wharton, J Taylor" uniqKey="Wharton J" first="J. Taylor" last="Wharton">J. Taylor Wharton</name><affiliation><mods:affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="ISSN">0090-8258</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1992">1992</date><biblScope unit="volume">44</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="240">240</biblScope><biblScope unit="page" to="244">244</biblScope></imprint><idno type="ISSN">0090-8258</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0090-8258</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma in situ. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>vulvar</json:string><json:string>node</json:string><json:string>vulva</json:string><json:string>invasive</json:string><json:string>gynecol</json:string><json:string>excision</json:string><json:string>carcinoma</json:string><json:string>obstet</json:string><json:string>inguinal</json:string><json:string>metastasis</json:string><json:string>recurrence</json:string><json:string>labium</json:string><json:string>microinvasive</json:string><json:string>squamous</json:string><json:string>oncol</json:string><json:string>resection</json:string><json:string>majus</json:string><json:string>lesion</json:string><json:string>vulvar carcinoma</json:string><json:string>invasive disease</json:string><json:string>lymph node metastasis</json:string><json:string>radical vulvectomy</json:string><json:string>dysplasia</json:string><json:string>microinvasive carcinoma</json:string><json:string>minimal invasion</json:string><json:string>squamous cell carcinoma</json:string><json:string>selective lymph node dissection</json:string><json:string>lymph</json:string><json:string>margin status</json:string><json:string>vulvar recurrence</json:string><json:string>vascular space invasion</json:string><json:string>symptom duration</json:string><json:string>squamous carcinoma</json:string><json:string>initial treatment</json:string><json:string>univariate analysis</json:string><json:string>invasive lesions</json:string><json:string>vulvar cancer</json:string><json:string>node dissection</json:string><json:string>dissection</json:string></teeft></keywords><author><json:item><name>Joseph L. Kelley, III</name><affiliations><json:string>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>Thomas W. Burke</name><affiliations><json:string>To whom correspondence should be addressed at Department of Gynecology, Box 67, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.</json:string><json:string>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>Carmen Tornos</name><affiliations><json:string>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>Mitchell Morris</name><affiliations><json:string>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>David M. Gershenson</name><affiliations><json:string>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>Elvio G. Silva</name><affiliations><json:string>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item><json:item><name>J.Taylor Wharton</name><affiliations><json:string>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</json:string></affiliations></json:item></author><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma in situ. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.</abstract><qualityIndicators><score>6.375</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612 x 756 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1803</abstractCharCount><pdfWordCount>2875</pdfWordCount><pdfCharCount>18930</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>265</abstractWordCount></qualityIndicators><title>Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy</title><pii><json:string>0090-8258(92)90050-S</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Mayo Clin. 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D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Thomas W.</forename><surname>Burke</surname></persName><affiliation>To whom correspondence should be addressed at Department of Gynecology, Box 67, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.</affiliation><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Carmen</forename><surname>Tornos</surname></persName><affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Mitchell</forename><surname>Morris</surname></persName><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0004"><persName><forename type="first">David M.</forename><surname>Gershenson</surname></persName><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0005"><persName><forename type="first">Elvio G.</forename><surname>Silva</surname></persName><affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><author xml:id="author-0006"><persName><forename type="first">J.Taylor</forename><surname>Wharton</surname></persName><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation></author><idno type="istex">9FC6FBF906EE2D3DF044D04C60CB82574B44E7E3</idno><idno type="DOI">10.1016/0090-8258(92)90050-S</idno><idno type="PII">0090-8258(92)90050-S</idno></analytic><monogr><title level="j">Gynecologic Oncology</title><title level="j" type="abbrev">YGYNO</title><idno type="pISSN">0090-8258</idno><idno type="PII">S0090-8258(00)X0201-6</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1992"></date><biblScope unit="volume">44</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="240">240</biblScope><biblScope unit="page" to="244">244</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1992</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma in situ. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.</p></abstract></profileDesc><revisionDesc><change when="1992">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/9FC6FBF906EE2D3DF044D04C60CB82574B44E7E3/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>YGYNO</jid><aid>9290050S</aid><ce:pii>0090-8258(92)90050-S</ce:pii><ce:doi>10.1016/0090-8258(92)90050-S</ce:doi><ce:copyright type="unknown" year="1992"></ce:copyright></item-info><head><ce:dochead><ce:textfn>Regular article</ce:textfn></ce:dochead><ce:title>Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy</ce:title><ce:author-group><ce:author><ce:given-name>Joseph L.</ce:given-name><ce:surname>Kelley</ce:surname><ce:suffix>III</ce:suffix><ce:cross-ref refid="AFF1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Thomas W.</ce:given-name><ce:surname>Burke</ce:surname><ce:cross-ref refid="COR1"><ce:sup>1</ce:sup></ce:cross-ref><ce:cross-ref refid="AFF1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Carmen</ce:given-name><ce:surname>Tornos</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>†</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Mitchell</ce:given-name><ce:surname>Morris</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>David M.</ce:given-name><ce:surname>Gershenson</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Elvio G.</ce:given-name><ce:surname>Silva</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>†</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>J.Taylor</ce:given-name><ce:surname>Wharton</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>1</ce:label><ce:text>To whom correspondence should be addressed at Department of Gynecology, Box 67, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.</ce:text></ce:correspondence></ce:author-group><ce:date-received day="8" month="7" year="1991"></ce:date-received><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma <ce:italic>in situ</ce:italic>. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Minimally invasive vulvar carcinoma: An indication for conservative surgical therapy</title></titleInfo><name type="personal"><namePart type="given">Joseph L.</namePart><namePart type="family">Kelley, III</namePart><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Thomas W.</namePart><namePart type="family">Burke</namePart><affiliation>To whom correspondence should be addressed at Department of Gynecology, Box 67, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030.</affiliation><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Carmen</namePart><namePart type="family">Tornos</namePart><affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Mitchell</namePart><namePart type="family">Morris</namePart><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David M.</namePart><namePart type="family">Gershenson</namePart><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Elvio G.</namePart><namePart type="family">Silva</namePart><affiliation>Department of Pathology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">J.Taylor</namePart><namePart type="family">Wharton</namePart><affiliation>Department of Gynecology, The University of Texas, M. D. Anderson Cancer Center, Houston, Texas 77030 U.S.A.</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1992</dateIssued><copyrightDate encoding="w3cdtf">1992</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">It has been proposed that squamous carcinoma of the vulva with 1 mm or less of stromal invasion can be treated with local resection without inguinal node dissection. A retrospective review of 255 cases of stages I and II vulvar carcinoma demonstrated 24 cases of minimally invasive carcinoma. All cases were subjected to detailed chart review and pathologic confirmation. Mean age at diagnosis was 60 years. Seven patients had a preoperative diagnosis of preinvasive disease, ten had stage I disease, and seven had stage II disease. Fifteen cases had associated vulvar carcinoma in situ. Treatment consisted of local excision in 2 patients, radical wide excision in 11, hemivulvectomy in 5, and radical vulvectomy in 6. Eleven patients had either unilateral or bilateral inguinal node dissection. Five-year life-table survival was 89%. Four patients (17%) developed recurrent dysplasia and four (17%) developed invasive recurrences. One invasive recurrence was in an inguinal node in a patient previously treated with a hemivulvectomy and negative ipsilateral superficial node dissection. Univariate analysis revealed no statistically significant associations between recurrence and age, symptom duration, margin status, location, FIGO stage, or coexisting VIN. Large areas of coexisting dysplasia and variable gross appearance make meaningful application of FIGO staging criteria difficult in lesions with minimal focal invasion. Wide excision or radical wide excision of lesions with “high-risk” VIN or those showing ⩽1 mm of stromal invasion on biopsy is adequate therapy. If final pathologic review demonstrates deeper invasion, a selective lymph node dissection can be performed as a second procedure. Careful surveillance with liberal use of colposcopy and biopsies is indicated in these patients.</abstract><note type="content">Section title: Regular article</note><relatedItem type="host"><titleInfo><title>Gynecologic Oncology</title></titleInfo><titleInfo type="abbreviated"><title>YGYNO</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199203</dateIssued></originInfo><identifier type="ISSN">0090-8258</identifier><identifier type="PII">S0090-8258(00)X0201-6</identifier><part><date>199203</date><detail type="volume"><number>44</number><caption>vol.</caption></detail><detail type="issue"><number>3</number><caption>no.</caption></detail><extent unit="issue pages"><start>205</start><end>295</end></extent><extent unit="pages"><start>240</start><end>244</end></extent></part></relatedItem><identifier type="istex">9FC6FBF906EE2D3DF044D04C60CB82574B44E7E3</identifier><identifier type="DOI">10.1016/0090-8258(92)90050-S</identifier><identifier type="PII">0090-8258(92)90050-S</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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