Gynecol Oncol 2000;79:6–10 This is a retrospective review of 132 women treated with cone biopsy for adenocarcinoma in situ at the Brigham and Women's Hospital over a 12‐year period. Seventy‐two percent of these patients were managed conservatively after cold‐knife cone or loop excision procedure; 28% eventually underwent a hysterectomy. The median age of the conservative management group was significantly lower than that of the hysterectomy group. During the follow‐up period that lasted 30 months, nine women required evaluation for follow‐up abnormalities after cone biopsy with negative margins. None of these nine patients had a recurrence of AIS. A hysterectomy was performed for undesired fertility or persistently positive conization margins. One woman required a hysterectomy for recurrent AIS. Thirteen, or 62%, of 21 hysterectomy specimens demonstrated residual AIS following cone biopsies with positive or unevaluable margins. Only 1 of 16 patients had residual AIS following cone biopsy with negative margins. The authors conclude that younger women with cervical AIS may be effectively treated with cone biopsy alone if negative margins can be achieved. Comment: This paper and the accompanying editorial point out that the standard of care for AIS when fertility is not indicated continues to be a hysterectomy. When patients desire fertility, AIS with negative margins appears to be a safe option. The authors also confirm that loop excision procedure is not as effective a treatment for AIS as cold knife conization. Additionally, the importance of having readable margins might be, and precludes, the use of thermal techniques that may hinder the ability to read the margins. (CJD)