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Long-Term Follow-Up Results From Women With Cervical Adenocarcinoma In Situ Treated by Conization: An Experience From a Large Academic Womens Hospital

Li, Zaibo MD, PhD; Zhao, Chengquan MD

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 452–458
doi: 10.1097/LGT.0b013e318283e2c6
Original Articles

Objectives: Cervical adenocarcinoma in situ (AIS) is the precursor to adenocarcinoma, and early management will often prevent the occurrence of invasive adenocarcinoma. Conservative treatment with conization has been proposed for the initial treatment for cervical AIS. To evaluate the risk of residual/recurrent disease after conization, we investigated the long-term follow-up results for patients with cervical AIS treated by conization.

Materials and Methods: One hundred thirty-six patients with a biopsy diagnosis of cervical AIS followed by conization were followed up with cytologic, histologic, and human papillomavirus testing.

Results: The rate of residual AIS in the following hysterectomy was significantly increased in patients with positive margins on the conization (48.6%, 17/35) compared to patients with negative margins (0/30). No significant disease was identified in patients treated by hysterectomy as primary treatment. More importantly, only 2 patients with conization as primary management had adenocarcinoma or focal AIS, respectively, during a long-term follow-up period (mean, 45 mo). However, one of them had positive margin on the conization and did not proceed to further treatment. The other one had negative margin on the conization but only had focal AIS on the hysterectomy. Human papillomavirus-positive rate showed no significant difference between patients treated by conization and patients treated by hysterectomy during the long-term follow-up.

Conclusions: Therefore, if a negative resection margin is achieved, conservative management with conization and careful surveillance is suitable for patients with cervical AIS and desire for future childbearing.

Conization with negative margins may be a reasonable management for women with adenocarcinoma in situ.

Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA

Reprint requests to: Chengquan Zhao, MD, Department of Pathology, Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, PA 15213. E-mail: zhaoc@upmc.edu

The author has declared that there are no conflicts of interest.

Presented at the 60th American Society of Cytopathology Annual Scientific Meeting, Las Vegas, NV, November 2–6, 2012.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology