Further study of the management of cervical adenocarcinoma in situ.

Objective: The objective of this study was to study further the management of cervical adenocarcinoma in situ (AIS) with particular regard to the results of conservative management without hysterectomy and the use of large loop excision of the transformation zone (LLETZ).

Methods: Based upon the files of the Pathology Department at the Cleveland Clinic Foundation, recently encountered AIS patients were combined with patients from a previous study that ended in 1994. Charts and clinical materials were retrospectively reviewed and abstracted.

Results: Fifty-two patients were identified for a combined study group of 98 patients. The mean age was 37 years. Fifty-two percent were identified due to abnormal squamous elements on a Pap smear and 43% due to abnormal glandular cells. In patients treated with hysterectomy, 67% were found to have residual disease following conization with positive margins including 3 patients with invasive cancer. Among all patients, LLETZ was associated with a positive margin rate of 57.1% vs 27.3% with cold knife conization (CKC) (chi(2), P = 0.008). Among patients treated conservatively with conization, the rates of positive margins were 40.0 and 20.0%, respectively, for LLETZ and CKC (chi(2), P = 0.11); 9.5% of conservatively managed patients with negative initial conization margins eventually had recurrent AIS.

Conclusion: Cold knife conization is the preferred method of management for cervical AIS patients selecting conservative treatment. Despite initial conization margins being uninvolved, such patients have an approximate risk of 10% for recurrent AIS.