Oncological and reproductive outcomes of adenocarcinoma in situ of the cervix managed with the loop electrosurgical excision procedure

Bai, Huimin; Li, Jun; Wang, Qiuxi; Feng, Ying; Lou, Tong; Wang, Shuzhen; Wang, Yue; Jin, Mulan; Zhang, Zhenyu

doi:10.1186/s12885-018-4386-6

Cited by 10 publications

(7 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…AIS coexisting with CIN in this study was found in about half of AIS women. This is a similar finding to the prevalence rates ranging from 40% to 60% reported by other studies [5,6,12,13,16,17]. Coexisting CIN showed a protective association with residual disease; however, it did not result in being a significant, independent factor in the multivariate analysis.…”

Section: Discussionsupporting

confidence: 91%

“…A conization depth of < 8 mm was found to reduce the risk of residual disease in multivariate analysis. A greater cone depth signifies a better chance to remove glandular lesions located in the cervical canal as well as a decreased risk for residual disease [5,15]. Historically, many studies have shown that cold-knife conization(CKC) is associated with a lower rate of positive margins than LEEP, because it produces a greater specimen volume and depth [13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Fertility-preservation surgery; such as cold-knife conization or loop electrosurgical excision procedure (LEEP), has been considered for patients who wish to retain their fertility. For over a decade, AIS has tended to occur in women of a younger age, and women tend to delay childbearing compared to in the past [5]. Hence, preservative surgery is now playing an increasingly important role in management of AIS.…”

Section: Prevalence Predictive Factors and Nomogram Of Residual Disease Following Cervical Conization For Adenocarcinoma In Situmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence, Predictive Factors and Nomogram of Residual Disease Following Cervical Conization for Adenocarcinoma in Situ

Boonyapipat

Pichamon²

2021

Asian Pac J Cancer Care

View full text Add to dashboard Cite

Objectives: To evaluate the prevalence of residual disease after conization in AIS women, and to develop a nomogram for predicting residual disease in such patients. Methods: Eighty-three cervical adenocarcinoma in situ (AIS) patients were retrospectively reviewed. Patient data concerning: demographic characteristics, colposcopic findings and diagnosis, type of conization, size of pathologic specimens, pathological characteristics, endocervical curettage (ECC) pathology and subsequent procedures, were collected. The rate of residual disease after conization and predictive factors for residual disease in subsequent hysterectomy were analyzed, and a predictive nomogram for residual disease was developed, based on the multivariate analysis results. The statistical significance was set at a p-value of <0.05.Results: The prevalence of residual disease in hysterectomy specimens following conization was 31.8%. Five (5.7%) women with AIS, who underwent subsequent hysterectomy, were found to have invasive adenocarcinoma. According to the multivariate analysis results, the predictive factors for residual disease were a positive endocervical margin status [OR 22.5 (95% CI 4.74, 106.79)] and a depth of specimen of < 8 mm [OR 8.11 (95% CI 1.12, 58.95)]. A nomogram for the prediction of residual disease in AIS women was developed, based on these predictive factors. After bootstrapping 1000 times, the bootstrap-corrected concordance index value for predicting residual disease was 0.852. Conclusion: The residual disease was found in 31.8% of hysterectomy specimens after conization for AIS. Residual disease was strongly associated with a positive endocervical margin and a depth of specimen of <8 mm. This study reports a feasible nomogram, with an acceptable level of accuracy for predicting the individual risk of residual disease; which may be beneficial in proper management decision-making.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Prevalence Predictive Factors and Nomogram Of Residual Disease Following Cervical Conization For Adenocarcinoma In Situmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence, Predictive Factors and Nomogram of Residual Disease Following Cervical Conization for Adenocarcinoma in Situ

Boonyapipat

Pichamon²

2021

Asian Pac J Cancer Care

View full text Add to dashboard Cite

show abstract

“…One patient had a recurrence of AIS, 1 had a spontaneous abortion, 4 had full-term deliveries, and an additional 3 pregnancies were ongoing at the time of the manuscript publication. Most recently, in 2018, Bai et al 20 published on 8 pregnancies after conservative treatment with negative margins, with 1 spontaneous abortion, 5 full-term deliveries, and 2 ongoing pregnancies at time of publication.…”

Section: Discussionmentioning

confidence: 99%

Fertility and Pregnancy Outcomes After Conservative Management of Adenocarcinoma In Situ of the Cervix

Bell

Peng

Kobernik

et al. 2021

J Low Genit Tract Dis

View full text Add to dashboard Cite

ObjectiveThe aim of the study was to evaluate the pregnancy outcomes of women who underwent conservative management of adenocarcinoma in situ (AIS).Materials and MethodsWe conducted a retrospective chart review of patients diagnosed with AIS at a single tertiary institution between January 1, 1991, and December 31, 2019. We collected demographic data, AIS-specific information, and fertility outcomes and performed bivariate analyses to compare demographic characteristics and AIS-specific information between patients with and without hysterectomy after diagnosis. Patients with conservative management who achieved pregnancy were described.ResultsAmong 87 patients with AIS, 38 (44%) underwent a hysterectomy within 6 months of diagnosis and 49 (56%) underwent conservative management. Six of 19 patients (32%) had residual AIS despite undergoing definitive management after an excisional procedure with negative margins and negative endocervical curettage (ECC). Nine of 19 patients (47%) had residual AIS after an excisional procedure with positive margins and/or a positive ECC. Patients who opted for conservative management were younger (median = 31.6 [interquartile range = 27.4–34.9] vs 38.5 y [32.3–44.8 y], p < .001) and nulligravid. Among patients with conservative management, there were 15 pregnancies and 14 live births (29%). Seven were preterm, although 2 were for medical indications.ConclusionsResidual AIS in patients with negative margins and ECC leading to definitive hysterectomy (32%) and the rate of preterm birth (36%) were higher than previous reports and nationally reported rates. However, only 1 patient had a preterm birth before 34 weeks. These findings reflect important information for counseling patients who elect for conservative management of AIS.

show abstract

“…7 The absence of HR-HPV types after LLETZ is currently not a factor that is considered in selecting operation or conservative treatment. 8 Human papillomavirus testing is done after LLETZ treatment of cervical intraepithelial neoplasia (CIN) to predict cure or risk for recurrence. 9 In the United Kingdom, a negative HR-HPV test at both 6 and 18 months after LLETZ allows a 3-year recall.…”

mentioning

confidence: 99%

The Association Between Clearance of Human Papillomavirus After Conization for Cervical Cancer and Absence of Cancer

Siegler

Goldberg

Siegler

et al. 2021

J Low Genit Tract Dis

View full text Add to dashboard Cite

Objectives:We assessed the relation between clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) and absence of residual disease, in women diagnosed with cervical cancer (CC) and adenocarcinoma in situ (AIS).Materials Methods: Data were collected from 92 women diagnosed with CC and AIS who were positive to HR-HPV and had a repeat cervical HPV test 3-12 weeks after LLETZ (in which CC/AIS were diagnosed) and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV after LLETZ. Results:The HR-HPV results after the LLETZ operation were negative in 40 women and positive in 52 women. The HR-HPV-negative group included a significantly higher incidence of AIS: 14 (35%) vs 5 (9.6%, p < .006). In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among 34 women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p < .0005). The positive predictive value for absence of residual cancer, with clearance of HR-HPV after LLETZ, was 95%.Conclusions: Clearance of HR-HPV from the cervix a short time after LLETZ has a high association with the absence of residual cancer in the final outcome, either in the pathology or the follow-up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

show abstract

Oncological and reproductive outcomes of adenocarcinoma in situ of the cervix managed with the loop electrosurgical excision procedure

Cited by 10 publications

References 40 publications

Prevalence, Predictive Factors and Nomogram of Residual Disease Following Cervical Conization for Adenocarcinoma in Situ

Prevalence, Predictive Factors and Nomogram of Residual Disease Following Cervical Conization for Adenocarcinoma in Situ

Fertility and Pregnancy Outcomes After Conservative Management of Adenocarcinoma In Situ of the Cervix

The Association Between Clearance of Human Papillomavirus After Conization for Cervical Cancer and Absence of Cancer

Contact Info

Product

Resources

About