Between 1987 and 1990, Tsuchiura Kyodo Hospital treated a total of 153 cases of squamous cell carcinoma of the uterine cervix after establishing definitive diagnosis. Of the total, 46 cases in stage 0, 43 cases in stage Ia and 21 cases in stage Ib were studied retrospectively in order to investigate the sensitivity of cytological and histological tests and the rate of agreement between cancer diagnoses made by the two departments. As a result, it was confirmed anew that there is much to be done to improve the diagnostic accuracy, which is vital to the success of the treatment for early cancer of the uterine cervix.
A summary of the findings is as follows:
The cytological examination data showed that the positive results were obtained in 69.6% of the cases in stage 0, 67.4% in stage Ia and 84.2% in stage Ib. The corresponding percentages in the histological examination were 50%, 67.5% and 89.5% respectively. The argreement rations were as low as 30% in stage 0, 53.8% in stage Ia and 84.2% in stage Ib.
Similar study was made on 43 cases of conization which is regarded as a useful means of detecting cervic cancer, The ratio of detection of early cervic cancer was 29.4% before conization. After conization, the ratio jumped to 74.4%.
The present level of diagnostic accuracy is such that the routine conization procedure is indispensable. For the treatment of cervical cancer in stage 0, it is advisable to perform hysterectomy. For the stage Ia cancer, semi-radical hysterectomy should be indicated. Lymph-node clearing is not always required.
In stage 0, diagnostic conization should be followed by treatmental conization or by removal of the remaing part of the uterus after making sure that the conization procedure was appropriate and taking into consideration the patients' age and fertility. In light of the present level of medical technology, however, hysterectomy may be the first to be considered.