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

- LEEP is associated with a higher rate of positive margins compared with CKC in patients with AIS.
- There is a high rate of residual disease at hysterectomy following cone biopsy for AIS.
- Patients undergoing conservative management for AIS should be counseled regarding the potential risks of residual and recurrent disease.

ObjectiveCervical 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.MethodsThe 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.ResultsThe 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.ConclusionPatients 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.