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Management of Adenocarcinoma In Situ of the Uterine Cervix: A Comparison of Loop Electrosurgical Excision Procedure and Cold Knife Conization

Latif, Nawar A. MD, MPH1; Neubauer, Nikki L. MD1; Helenowski, Irene B. MS, PHD2; Lurain, John R. MD1

Journal of Lower Genital Tract Disease: April 2015 - Volume 19 - Issue 2 - p 97–102
doi: 10.1097/LGT.0000000000000055
Original Articles: Cervix and HPV

Objective: This study aimed to compare loop electrosurgical excision procedure (LEEP) with cold knife conization (CKC) as therapeutic management procedures for women with adenocarcinoma in situ (ACIS) of the cervix.

Methods: We conducted a retrospective chart review of all patients who underwent a conization procedure with a preoperative or postoperative diagnosis of ACIS of the cervix from 1997 to 2011. Data gathered included demographics, risk factors, pretreatment Pap test and colposcopic biopsy results, conization pathology including presence of invasive cancer and margin status, subsequent need for reconization or hysterectomy, and follow-up. Outcome measures, such as diagnosis of invasive cancer, margin status, and recurrence of ACIS or development of invasive cancer, were compared between LEEP and CKC.

Results: Of 115 conization procedures performed, 61 were LEEP (31 diagnostic and 30 therapeutic) and 54 were CKC (6 diagnostic and 48 therapeutic). Patients who underwent CKC were more often nulliparous, on oral contraceptive pills, and smoking cigarettes than patients who underwent LEEP. For the 78 patients who underwent conization procedures with therapeutic intent, there were no differences in the rates of positive margins (20% vs 17%), invasive cancer (3.3% vs 4.2%), recurrence of ACIS (6.7% vs 8.3%), or subsequent development of invasive adenocarcinoma (0 vs 2.0%) between LEEP and CKC, respectively.

Conclusions: In our study, LEEP was as good as CKC for the treatment of ACIS of the cervix, achieving the same rates of negative margins, diagnosis of invasive cancer, and recurrence of ACIS or invasive cancer. The benefits of LEEP versus CKC include the ability to perform the procedure in an outpatient clinic under local anesthesia with less morbidity. Patients treated for ACIS of the cervix by a conization procedure need careful, regular follow-up given the risk of recurrent ACIS or invasive cancer.

LEEP had the same rates of negative margins, diagnosis of invasive cancer, recurrence of ACIS, and risk of subsequent invasive cancer compared to CKC.

1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL

The authors have declared they have no conflicts of interest.

Reprint requests to: Nawar A. Latif, MD, MPH, 3400 Civic Center Blvd, Third Floor West Philadelphia, PA 19104. E-mail:

Presented at the 14th Biennial Meeting of the International Gynecologic Cancer Society Vancouver, Canada, October 13–16, 2012.

Copyright © 2015 by the American Society for Colposcopy and Cervical Pathology