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Am J Obstet Gynecol. 2014 Apr;210(4):366.e1-366.e5. doi: 10.1016/j.ajog.2013.12.030. Epub 2013 Dec 24.

Cervical conization of adenocarcinoma in situ: a predicting model of residual disease.

Author information

1
Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, School of Medicine, Los Angeles, CA.
2
Department of Pathology, University of Southern California, Los Angeles, School of Medicine, Los Angeles, CA.
3
Department of Preventive Medicine, University of Southern California, Los Angeles, School of Medicine, Los Angeles, CA.

Abstract

OBJECTIVE:

To determine factors associated with the presence of residual disease in women who have undergone cervical conization for adenocarcinoma in situ (ACIS) of the cervix.

STUDY DESIGN:

We identified women who underwent a cervical conization for a diagnosis of ACIS followed by repeat conization or hysterectomy between Jan. 1, 1995, and April 30, 2010. Data were summarized using standard descriptive statistics.

RESULTS:

Seventy-eight patients met study criteria. The presence of ACIS at the internal conization margin or in the postconization endocervical curettage (ECC) correlated with residual ACIS (P < .001). A margin positive for ACIS was associated with residual glandular neoplasia in 68% of cases. An endocervical curettage positive for ACIS was associated with residual ACIS in 95% of cases. If both the margins and the endocervical curettage were positive for the presence of ACIS, 8% did not have residual disease, 77% had residual ACIS, and 15% had invasive adenocarcinoma. If both the internal conization margin and the postconization ECC were negative for the presence of ACIS, 14% of the final specimens had residual ACIS and none had invasive cancer.

CONCLUSION:

The addition of postconization ECC to cone biopsy for ACIS of the cervix provides valuable prognostic information regarding the risk of residual ACIS. Women with ACIS who have both a negative postconization ECC and a negative conization margin have a 14% risk for residual ACIS and can be treated conservatively if desiring fertility. A positive postconization ECC or internal margin incurs significant risk of residual disease and 12-17% will have cancer.

KEYWORDS:

adenocarcinoma in situ, cervical dysplasia, conservative management, endocervical curettage

PMID:
24370689
DOI:
10.1016/j.ajog.2013.12.030
[Indexed for MEDLINE]

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