INITIAL EVALUATION OF CERVICAL CANCER: A LITERATURE REVIEW OF STAGING CONIZATION FOR ACCURATE RISK STRATIFICATION AND GUIDANCE OF PRIMARY TREATMENT IN EARLY-STAGE DISEASE - A REVIEW FROM THE FRENCH CERVICAL CANCER GUIDELINES GROUP - 09/09/26

Doi : 10.1016/j.jogoh.2026.103274

Walid Chlala ¹, Amélia Favier ^2,³, Xavier Carcopino ⁴, Geoffroy Canlorbe ^2,^5,⁶, Claire Sanson ^1,^⁎ ,
the members from the FRENCH CERVICAL CANCER GUIDELINES GROUP ^{^#}
Authors from the FRENCH CERVICAL CANCER GUIDELINES GROUP

Xavier Carcopino ^4,^⁎, Lobna Ouldamer ⁷, Cyrille Huchon ⁸, Pauline Asseeva ⁹, Henri Azaïs ¹⁰, Sofiane Bendifallah ¹¹, Jean-Luc Brun ¹², Geoffroy Canlorbe ¹³, Cyrus Chargari ¹⁴, Pauline Chauvet ¹⁵, Abel Cordoba ¹⁶, Hélène Courcier ¹⁷, Yohann Dabi ¹⁸, Marion de Berti ¹², Caroline Diguisto ¹², Eva Fuss ¹⁹, Thomas Gaillard ²⁰, Tristan Gauthier ²¹, Witold Gertych ²², Laurence Gladieff ²³, Olivier Graesslin ²⁴, Yohan Kerbage ²⁵, Martin Koskas ¹⁷, Enora Laas ²⁰, Aymeline Lacorre ²¹, Vincent Lavoué ²⁶, Lise Lecointre ¹⁹, Fabrice Lecuru ²⁷, François Margueritte ²¹, Alejandra Martinez ²⁸, Paul-Jean Maternowski ¹², Patrice Mathevet ^29,³⁰, Imane Menouer ²⁴, Camille Mimoun ¹³, Anthony Moureau ²⁶, Antoine Netter ⁶, Charles-André Philip ³¹, Pascal Rousset ³², Claire Sanson ³³, Isabelle Thomassin-Naggara ³⁴, Cyril Touboul ¹⁸, Jean Levêque ²⁶

⁴ Department of Obstetrics and Gynaecology, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), CEReSS, Center for Studies and Research on Health Services and Quality of Life, Aix Marseille University (AMU), Marseille, France

⁶ Sorbonne University, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Biology and Therapeutics of Cancer, Paris, France

⁷ Department of Gynecology, Centre Hospitalier Universitaire de Tours, INSERM U1069; Université François-Rabelais, Tours, France

⁸ Department of Obstetrics and Gynaecology, Lariboisière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Paris Cité University, Paris, France

⁹ Department of Nuclear Medicine, Hôpital Nord, Assistance Publique–Hôpitaux de Marseille (APHM), Marseille, France

¹⁰ Department of Gynecologic and Breast Cancer Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris Cité University, Paris, France

¹¹ Department of Gynaecologic Surgery, American Hospital of Paris, Neuilly-sur-Seine, France

¹² Department of Gynaecologic Surgery and Reproductive Medicine, Aliénor d’Aquitaine Center, Pellegrin Hospital, Bordeaux, France

¹³ Department of Gynaecologic and Breast Cancer Surgery, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Paris, France

¹⁴ Department of Radiation Oncology, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

¹⁵ Department of Obstetrics and Gynaecology, Estaing University Hospital, Clermont Auvergne University, EnCoV, Institut Pascal, CNRS UMR 6602, SIGMA Clermont, Clermont-Ferrand, France

¹⁶ Department of Radiation Therapy, Centre Oscar Lambret, Lille, France

¹⁷ Department of Obstetrics and Gynaecology, Bichat Hospital, Paris Cité University, Paris, France

¹⁸ Department of Obstetrics and Gynaecology and Reproductive Medicine, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

¹⁹ Department of Gynaecologic Surgery, Hautepierre University Hospital, Strasbourg, France

²⁰ Department of Gynaecologic, Breast and Reconstructive Surgery, Institut Curie, Paris, France

²¹ Department of Obstetrics and Gynaecology, Women, Mothers and Children Hospital (HFME), Limoges University Hospital, Limoges, France

²² Department of Gynaecologic and Oncologic Surgery, Lyon Sud Hospital, Lyon, France

²³ Department of Medical Oncology, Oncopole Claudius Regaud, IUCT-Oncopole, Toulouse, France

²⁴ Alix de Champagne Mother and Child Institute, Reims University Hospital, University of Reims Champagne-Ardenne (URCA), Reims, France

²⁵ Department of Gynaecologic Surgery, Lille University Hospital, University of Lille, INSERM U1189, OncoThAI: Laser-Assisted Therapies and Immunotherapies for Oncology, Lille, France

²⁶ Department of Gynaecology, Obstetrics and Human Reproduction, CHU Anne de Bretagne, Faculty of Medicine, University of Rennes, IRSET, INSERM U1085, Rennes, France

²⁷ Department of Breast, Gynaecologic and Reconstructive Surgery, Institut Curie, Faculty of Medicine, Paris Cité University, Paris, France

²⁸ Oncopole Claudius Regaud, Toulouse University Cancer Institute-Oncopole, Toulouse III–Paul Sabatier University, INSERM, CNRS, University of Toulouse, Toulouse Cancer Research Center, UMR1037, Toulouse, France

²⁹ Lausanne University Hospital (CHUV), Lausanne, Switzerland

³⁰ University of Lausanne (UNIL), Lausanne, Switzerland

³¹ Women and Children Hospital, Hospices Civils de Lyon (HCL), LabTAU INSERM U1032, Claude Bernard Lyon 1 University, Lyon, France

³² Department of Medical and Interventional Imaging, Lyon Sud University Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, EA CICLY, Lyon, France

³³ Department of Gynaecologic Surgery, Paris Saint-Joseph Hospital Group, Paris, France

³⁴ Department of Medical Imaging, Tenon Hospital, Assistance Publique–Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France

¹ Department of Gynecological and Breast Surgery and Oncology, Groupe Hospitalier Paris Saint Joseph, Paris, France

² Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France

³ Sorbonne Université, Inserm, UMR 938, Centre de Recherche Saint Antoine, Equipe Instabilité des Microsatellites et Cancer, Paris, France

⁵ University Institute of Cancer (IUC), AP-HP, Sorbonne University, Paris, France

^⁎ Corresponding author. Claire Sanson, University Institute of Cancer (IUC), AP-HP, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Biology and Therapeutics of Cancer, Paris, France University Institute of Cancer (IUC), AP-HP, Saint-Antoine Research Center (CRSA), INSERM UMR_S_938, Biology and Therapeutics of Cancer Paris France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Wednesday 09 September 2026

ABSTRACT

Prognosis and treatment decisions in early-stage cervical cancer depend on tumor size, depth of stromal invasion, margin status, and lymphovascular space invasion (LVSI). Although pelvic MRI is central to preoperative assessment, imaging may underestimate microscopic invasion or occult residual disease and cannot reliably assess LVSI. This narrative review summarizes evidence on diagnostic or staging conization in early-stage cervical cancer. A literature search was conducted in PubMed/MEDLINE, Embase, and the Cochrane Library, using terms related to cervical cancer, conization, FIGO staging, LVSI, residual disease, parametrial and nodal involvement, recurrence, and survival. Original studies, cohort studies, case-control studies, meta-analyses, and relevant reviews published in English or French were considered, and results were synthesized qualitatively. Conization provides direct histopathological assessment of tumor size, depth of stromal invasion, margin status, and LVSI, thereby improving FIGO staging and preoperative risk stratification. Available studies suggest that conization may predict residual disease and identify high-risk pathological features, including parametrial and lymph node involvement. LVSI detected on the cone specimen is consistently associated with higher risks of parametrial invasion, nodal metastasis, poorer recurrence-free survival, and, in some studies, reduced overall survival. Beyond its diagnostic value, preoperative conization may have a therapeutic impact. Retrospective studies suggest that conization before radical hysterectomy may be associated with a reduced risk of recurrence, particularly in patients undergoing minimally invasive surgery, whereas its impact on overall survival remains uncertain.Overall, staging conization may refine preoperative assessment, guide risk-adapted treatment, and potentially improve recurrence-related outcomes. Prospective studies are needed to clarify its oncological impact.

Le texte complet de cet article est disponible en PDF.

Keywords : early-stage cervical cancer, staging conization;lymphovascular space invasion (LVSI), parametrial involvement, lymph node metastasis, recurrence-free survival (RFS)