This protocol applies to patients with cervical cancer FIGO stage IA1 in whom lymphovascular space invasion (LVSI) is identified. The presence of LVSI at this otherwise early stage distinguishes these patients clinically and has direct implications for surgical planning.

LVSI is associated with an increased risk of pelvic lymph node involvement compared with stage IA1 disease without LVSI. As a result, evaluation and management of the pelvic lymph nodes — including whether sentinel lymph node biopsy is appropriate — is a key element of decision-making for this group and should be discussed with the patient.

Treatment approach — partial overview

Management is surgical, with the approach centred on appropriate lymph node assessment given the elevated nodal risk conferred by LVSI. For patients not seeking to preserve fertility, the recommended pathway includes a defined hysterectomy type combined with pelvic lymph node dissection. For those in whom fertility sparing is a priority, a distinct surgical alternative is available. The complete protocol — covering procedural selection criteria, lymph node dissection scope, the role of sentinel node biopsy, and further nodal staging options — is set out in the full structured regimen.

References

DOI: 10.1093/annonc/mdx220

In stage IA1 with LVSI, surgical assessment of pelvic lymph nodes should be discussed with the patient, including the sentinel lymph node (SLN, see below).
For patients with LVSI, who have an increased risk of lymph node involvement, pelvic lymph node dissection (PLND) is recommended.
Sentinel node biopsy should be considered.
Moreover, for these patients, some authors suggest trachelectomy, a surgical procedure in which the uterine cervix and adjacent tissues are removed [II, B].

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Treatment of Cervical Cancer FIGO Stage IA1 with Lymphovascular Space Invasion (LVSI)

References