Walid Chlala, Amélia Favier, Xavier Carcopino, Geoffroy Canlorbe, Claire Sanson, members from the FRENCH CERVICAL CANCER GUIDELINES GROUP, Xavier Carcopino, Lobna Ouldamer, Cyrille Huchon, Pauline Asseeva, Henri Azaïs, Sofiane Bendifallah, Jean-Luc Brun, Geoffroy Canlorbe, Cyrus Chargari, Pauline Chauvet, Abel Cordoba, Hélène Courcier, Yohann Dabi, Marion de Berti, Caroline Diguisto, Eva Fuss, Thomas Gaillard, Tristan Gauthier, Witold Gertych, Laurence Gladieff, Olivier Graesslin, Yohan Kerbage, Martin Koskas, Enora Laas, Aymeline Lacorre, Vincent Lavoué, Lise Lecointre, Fabrice Lecuru, François Margueritte, Alejandra Martinez, Paul-Jean Maternowski, Patrice Mathevet, Imane Menouer, Camille Mimoun, Anthony Moureau, Antoine Netter, Charles-André Philip, Pascal Rousset, Claire Sanson, Isabelle Thomassin-Naggara, Cyril Touboul, Jean Levêque
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.