Conservative Management of Adenocarcinoma In Situ of the Cervix

Abstract

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)

A clinical review of borderline glandular cells reported on liquid‐based cervical cytology

“…Glandular lesions are also more likely to be multifocal and deeper in the endocervical canal in older than younger women. 16,17 Despite this, the colposcopic impression in our series was the most important predictive factor for the presence or absence of significant disease in women under 35 years of age. No women in this group had an unsatisfactory colposcopy, and a negative colposcopy was associated with a 100% negative predictive value.…”

Preserving Fertility After Cancer

“…In contrast, other authors have reported more promising results in their retrospective studies. Shin et al 102 reported a small series of patients with AIS. Of 132 patients identified as having AIS, 95 patients were conservatively managed with either a cold knife cone or loop electrosurgical excision procedure, and 37 underwent hysterectomy.…”

“…There were no recurrences of AIS or invasive adenocarcinoma. 102 In general, the standard recommendation for women with AIS is hysterectomy, but cone biopsies can be done if the margins are negative and the patient fully understands the necessity as well as the challenges of follow up, specifically the difficulty of adequately sampling the endocervical canal. Further recommendations include consulting with a gynecologic oncolo-gist and obtaining a review by another pathologist.…”

Risk of persistent or recurrent neoplasia in conservatively treated women with cervical adenocarcinoma in situ with negative histological margins

“…The optimal management of adenocarcinoma‐in‐situ (AIS) of the uterine cervix after conservative treatment with cold knife cone biopsy (CKC) or loop electrosurgical excision procedure (LEEP) remains controversial . Positive or close histopathological margins are associated with an increased risk of AIS persistence and recurrence , but whether hysterectomy should be performed as definitive treatment in margin‐negative AIS remains uncertain . To date there have been conflicting reports regarding the rates of subsequent cervical neoplasia in these women .…”