J Gynecol Oncol.  2011 Mar;22(1):25-31. 10.3802/jgo.2011.22.1.25.

The safety of conization in the management of adenocarcinoma in situ of the uterine cervix

• Kim ML
• Hahn HS
• Lim KT
• Lee KH
• Kim HS
• Hong SR
• Kim TJ

• KMID: 2173582
• DOI: http://doi.org/10.3802/jgo.2011.22.1.25

Abstract

OBJECTIVE
To evaluate the occurrence of residual or recurrent disease after conization for adenocarcinoma in situ (AIS) of the uterine cervix.
METHODS
Medical records of 99 patients with a histologically diagnosis of AIS of the uterine cervix by conization between 1991 and 2008 were reviewed retrospectively.
RESULTS
Seventy eight of 99 patients (78.8%) had negative and 18 (18.2%) had positive resection margins of the conization specimen, and 3 (3.0%) had unknown margin status. Of the 78 patients with negative margins, 45 underwent subsequent hysterectomy and residual AIS were present in 4.4% (2/45) of patients. Ten of the 18 patients with positive margins received subsequent hysterectomy and 3 patients (30%) had residual AIS. Twenty-eight patients had conservative treatment and during the median follow-up time of 23.5 months (range, 7 to 124 months), only one patient (3.6%) had recurrent AIS and was treated with a simple hysterectomy. Eight patients became pregnant after conization, 4 of them delivered healthy babies, one had a spontaneous abortion and 3 were ongoing pregnancies.
CONCLUSION
Patients with positive resection margins after conization for AIS of the uterine cervix are significantly more likely to have residual disease. However, negative resection margin carries a lower risk for residual AIS, therefore conservative management with careful surveillance seems to be feasible in women who wish to preserve their fertility.

Keyword

Adenocarcinoma in situ; Uterine cervix cancer; Conization; Conservative treatment

MeSH Terms

Abortion, Spontaneous
Adenocarcinoma
Cervix Uteri
Conization
Female
Fertility
Follow-Up Studies
Humans
Hysterectomy
Medical Records
Pregnancy

Reference

1. Sherman ME, Wang SS, Carreon J, Devesa SS. Mortality trends for cervical squamous and adenocarcinoma in the United States. Relation to incidence and survival. Cancer. 2005. 103:1258–1264.

2. Han CH, Cho HJ, Lee SJ, Bae JH, Bae SN, Namkoong SE, et al. The increasing frequency of cervical cancer in Korean women under 35. Cancer Res Treat. 2008. 40:1–5.

3. Madeleine MM, Daling JR, Schwartz SM, Shera K, McKnight B, Carter JJ, et al. Human papillomavirus and long-term oral contraceptive use increase the risk of adenocarcinoma in situ of the cervix. Cancer Epidemiol Biomarkers Prev. 2001. 10:171–177.

4. Christopherson WM, Nealon N, Gray LA Sr. Noninvasive precursor lesions of adenocarcinoma and mixed adenosquamous carcinoma of the cervix uteri. Cancer. 1979. 44:975–983.

5. Kim WS, Lee TS. Adenocarcinoma in situ of the cervix. Korean J Gynecol Oncol Colposc. 1998. 9:140–143.

6. Kim JH, Park JY, Kim DY, Kim YM, Kim YT, Nam JH. The role of loop electrosurgical excisional procedure in the management of adenocarcinoma in situ of the uterine cervix. Eur J Obstet Gynecol Reprod Biol. 2009. 145:100–103.

7. Costa S, Negri G, Sideri M, Santini D, Martinelli G, Venturoli S, et al. Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix. Gynecol Oncol. 2007. 106:170–176.

8. Salani R, Puri I, Bristow RE. Adenocarcinoma in situ of the uterine cervix: a metaanalysis of 1278 patients evaluating the predictive value of conization margin status. Am J Obstet Gynecol. 2009. 200:182.e1–182.e5.

9. McHale MT, Le TD, Burger RA, Gu M, Rutgers JL, Monk BJ. Fertility sparing treatment for in situ and early invasive adenocarcinoma of the cervix. Obstet Gynecol. 2001. 98:726–731.

10. Ostor AG, Duncan A, Quinn M, Rome R. Adenocarcinoma in situ of the uterine cervix: an experience with 100 cases. Gynecol Oncol. 2000. 79:207–210.

11. Shin CH, Schorge JO, Lee KR, Sheets EE. Conservative management of adenocarcinoma in situ of the cervix. Gynecol Oncol. 2000. 79:6–10.

12. Kennedy AW, Biscotti CV. Further study of the management of cervical adenocarcinoma in situ. Gynecol Oncol. 2002. 86:361–364.

13. Soutter WP, Haidopoulos D, Gornall RJ, McIndoe GA, Fox J, Mason WP, et al. Is conservative treatment for adenocarcinoma in situ of the cervix safe? BJOG. 2001. 108:1184–1189.

14. Young JL, Jazaeri AA, Lachance JA, Stoler MH, Irvin WP, Rice LW, et al. Cervical adenocarcinoma in situ: the predictive value of conization margin status. Am J Obstet Gynecol. 2007. 197:195.e1–195.e7.

15. Dalrymple C, Valmadre S, Cook A, Atkinson K, Carter J, Houghton CR, et al. Cold knife versus laser cone biopsy for adenocarcinoma in situ of the cervix: a comparison of management and outcome. Int J Gynecol Cancer. 2008. 18:116–120.

16. Girardi F, Heydarfadai M, Koroschetz F, Pickel H, Winter R. Cold-knife conization versus loop excision: histopathologic and clinical results of a randomized trial. Gynecol Oncol. 1994. 55:368–370.

17. Mathevet P, Dargent D, Roy M, Beau G. A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP. Gynecol Oncol. 1994. 54:175–179.

18. Wright TC Jr, Gagnon S, Richart RM, Ferenczy A. Treatment of cervical intraepithelial neoplasia using the loop electrosurgical excision procedure. Obstet Gynecol. 1992. 79:173–178.

19. Giacalone PL, Laffargue F, Aligier N, Roger P, Combecal J, Daures JP. Randomized study comparing two techniques of conization: cold knife versus loop excision. Gynecol Oncol. 1999. 75:356–360.

20. Andersen ES, Nielsen K. Adenocarcinoma in situ of the cervix: a prospective study of conization as definitive treatment. Gynecol Oncol. 2002. 86:365–369.

21. Phadnis SV, Atilade A, Young MP, Evans H, Walker PG. The volume perspective: a comparison of two excisional treatments for cervical intraepithelial neoplasia (laser versus LLETZ). BJOG. 2010. 117:615–619.

22. Bosch FX, Burchell AN, Schiffman M, Giuliano AR, de Sanjose S, Bruni L, et al. Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine. 2008. 26:Suppl 10. K1–K16.

23. Park JY, Bae J, Lim MC, Lim SY, Lee DO, Kang S, et al. Role of high risk-human papilloma virus test in the follow-up of patients who underwent conization of the cervix for cervical intraepithelial neoplasia. J Gynecol Oncol. 2009. 20:86–90.

24. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. J Low Genit Tract Dis. 2007. 11:223–239.