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Preinvasive and Invasive Cervical Adenocarcinoma: Preceding Low-Risk or Negative Pap Result Increases Time to Diagnosis

Moukarzel, Lea A. MD; Angarita, Ana M. MD; VandenBussche, Christopher MD, PhD; Rositch, Anne PhD, MSPH; Thompson, Carol B. MS, MBA; Fader, Amanda N. MD; Levinson, Kimberly MD, MPH

Journal of Lower Genital Tract Disease: April 2017 - Volume 21 - Issue 2 - p 91–96
doi: 10.1097/LGT.0000000000000286
Original Research Articles: Cervix and HPV

Objectives The aims of the study were to investigate screening histories of women with adenocarcinoma in situ (AIS) and adenocarcinoma (AdCa) of the cervix and to further evaluate screening for glandular disease.

Materials and Methods Screening histories were retrospectively collected for patients with AIS or AdCa at a single large-volume academic institution from 2005 to 2015. Fisher exact and Wilcoxon rank sum tests were used to compare AIS with AdCa patient characteristics, distribution of preceding Pap (i.e., trigger Pap) results, and high-risk human papillomavirus testing. The association between Pap result and time to diagnosis was evaluated.

Results Eighty-seven cases, 50 AIS and 37 AdCa, met study criteria; median age was 31 and 43 years, respectively. Among the AIS cohort, 52.0% had a negative or low-risk trigger Pap result versus 24.3% of those with AdCa (p = .001). The time to diagnosis of AIS ranged from 8.4 to 18.8 weeks for those with high- versus low-risk or negative trigger Pap results, respectively (p = .002). The time to diagnosis of AdCa ranged from 14.6 to 44.7 weeks for those with high- versus low-risk or negative trigger Pap results, respectively (p = .003). Among those with high-risk human papillomavirus testing, 89.7% tested positive at the time of trigger Pap with 100% positivity among those with low-risk or negative trigger Pap results.

Conclusions Cervical AIS and AdCa affect many young nulliparous women and commonly preceded by low-risk or negative Pap testing. The interval to diagnosis increases with low-risk and negative Pap results, and therefore, further investigation into optimal screening for glandular lesions is needed.

Many women diagnosed with preinvasive and invasive glandular lesions of the cervix will have preceding low-risk or negative Pap results, which may delay diagnosis.

1Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, 2Department of Pathology, Johns Hopkins Medicine, Baltimore, MD; and 3Department of Epidemiology, 4Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Correspondence to: Kimberly Levinson, MD, MPH, Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, N Wolfe St, Phipps 279, Baltimore, MD 21287. E-mail:

The authors have declared they have no conflicts of interest.

Copyright © 2017 by the American Society for Colposcopy and Cervical Pathology