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Gynecol Oncol. 2000 Oct;79(1):6-10.

Conservative management of adenocarcinoma in situ of the cervix.

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1
Division of Gynecologic Oncology, Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA.

Abstract

OBJECTIVE:

The purpose of this study was to determine the method of treatment and outcome of women with cervical adenocarcinoma in situ (AIS).

METHODS:

Following institutional review board approval, all women diagnosed with cervical AIS from 1987 to 1999 were identified. Data were retrospectively collected by record review and correspondence with medical providers.

RESULTS:

Of 132 women treated with cone biopsy for AIS, 95 (72%) were managed conservatively after cold knife cone or loop electrical excisional procedure alone; 37 (28%) eventually underwent hysterectomy. The median age of diagnosis was 29 years (range, 17-47) in the conservative management group and 40 years (range, 25-72) in the hysterectomy group (P < 0.0001). Seventy-four percent were nulliparous in the conservative group compared with 27% in the hysterectomy group (P < 0.0001). Of the 95 conservatively managed patients, 92 obtained negative margins; three were followed despite positive or unevaluable margins. During a median follow-up of 30 months, 9 women required evaluation for follow-up abnormalities after cone biopsy with negative margins. None had pathologic evidence of recurrent AIS. Twenty-three infants were delivered. Hysterectomy was generally performed for undesired fertility or persistently positive cone margins. One woman required hysterectomy for recurrent AIS. Thirteen (62%) of twenty-one hysterectomy specimens had residual AIS following cone biopsy with positive or unevaluable margins; 1 (6%) of 16 had residual AIS following cone biopsy with negative margins (P < 0.0001). No patient developed invasive adenocarcinoma.

CONCLUSIONS:

Younger women with cervical AIS may be effectively treated with cone biopsy alone if negative margins can be achieved.

PMID:
11006022
DOI:
10.1006/gyno.2000.5962
[Indexed for MEDLINE]
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