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.

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.