Young women who present with stage Ia carcinoma of the uterine cervix may strongly desire preservation of fertility. There is little published information on the outcome of patients treated for early invasive cervical cancer with cervical conization. Patients were considered eligible for conservative management if they had a squamous lesion invading to a depth less than or equal to 3 mm with no lymphatic or vascular space involvement and negative margins. We identified 14 patients who had been treated by cervical conization alone for early invasive carcinoma of the cervix. Pathologic variables were reviewed for all patients. Patient records were retrospectively reviewed for demographic, pathologic, and follow-up information. The mean depth of invasion was 1.6 mm (range, 0.5-2.8 mm). The mean number of cone sections evaluated was nine (range, 6-13 sections). The median follow-up period following conization was 26.5 months (range, 1-170 months). One patient underwent subsequent hysterectomy and was found to have mild dysplasia. Thirteen patients have retained their uteri and none has developed recurrent invasive or preinvasive lesions. We conclude that cervical conization is an acceptable therapy for selected cases of microinvasive squamous carcinoma of the uterine cervix. Larger studies of this patient group are indicated to confirm the safety of conization as definitive therapy in selected cases of early invasive cervical carcinoma.