Risk of residual disease and invasive carcinoma in women treated for adenocarcinoma in situ of the cervix

• Published in: Gynecologic oncology Vol. 129; no. 3; pp. 513 - 516
• Main Authors: Costales, Anthony B, Milbourne, Andrea M, Rhodes, Helen E, Munsell, Mark F, Wallbillich, John J, Brown, Jubilee, Frumovitz, Michael, Ramondetta, Lois M, Schmeler, Kathleen M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2013
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adolescent; Adult; Aged; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Cervical adenocarcinoma in-situ; Cervical cancer; Cervical cone biopsy; Cervical dysplasia; Cohort Studies; Conization - methods; Cryosurgery - methods; Electrosurgery - methods; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysterectomy; Middle Aged; Neoplasm Invasiveness; Neoplasm, Residual; Obstetrics and Gynecology; Risk Factors; Treatment Outcome; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Young Adult; Cervical adenocarcinoma in-situ; Cervical cone biopsy; Cervical dysplasia; Cervical cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2013.03.015

Abstract Objective Cervical adenocarcinoma in situ (AIS) is increasing in incidence among reproductive-age women. Cervical conization is an alternative to hysterectomy that allows future fertility, however reports regarding the risk of residual AIS and underlying adenocarcinoma are conflicting. The purpose of this study was to determine the outcomes of a large cohort of women treated for AIS. Methods The medical records of 180 women with cervical AIS evaluated at the University of Texas MD Anderson Cancer Center and its outlying clinics between 1983 and 2011 were reviewed for demographic information, treatment history, pathologic findings and outcomes. Results The mean age at diagnosis was 33.8 years (range 17.6–76.1 years). 172 of the 180 women had at least one cone biopsy performed, with 110 (64.0%) undergoing a cold knife cone (CKC), and 62 (36.0%) undergoing a loop electrosurgical excision procedure (LEEP) as their initial method of treatment. Positive margins were noted in 35.0% of patients undergoing CKC compared with 55.6% undergoing LEEP (p = 0.017). 71 patients ultimately underwent hysterectomy with residual disease noted in 10 patients (14.1%), 8 patients (11.3%) with residual AIS and 2 patients (2.8%) with invasive carcinoma. Of the 101 patients who did not undergo hysterectomy, 2 patients (2.0%) developed recurrent AIS at a median of 27.5 months (range 18–37 months) from the last cone, and none developed invasive carcinoma. Conclusion Patients undergoing conservative management for AIS with cervical conization alone should be monitored closely and counseled regarding the potential risks of residual and recurrent disease, even when negative cone margins are obtained.