Adenocarcinoma in Situ of the Cervix: A Prospective Study of Conization as Definitive Treatment

An Investigation of the Mechanisms Underlying the Disparity Between Rate of Residual Endocervical Adenocarcinoma In Situ (AIS) in Hysterectomy Specimens and Clinical Failure Rate Following Conservatively Treated AIS

“…3,7 The clinical and pathologic features of these 2 forms of clinical failures (recrudescence of residual AIS and de novo AIS) might explain the broad range of time intervals between cone biopsy and failure in the 27 histologically documented, post-cone biopsy recurrences reported by other authors. 3,4,6,10,13,15,17,18,21,[23][24][25] Clinical failures in these patients segregated into 2 time frames. Almost half of the failures (12 [44%]) followed a long disease-free interval of 2 or more years after cone biopsy excision, and 8 of these occurred more than 4 years after the procedure.…”

“…Differences between and the independent functioning of the 2 processes (a second de novo AIS neoplasm and posttreatment residual AIS eradication) also might underlie the lack of correlation between cone biopsy margin status and the risk of clinical failure observed by other authors. 3,4,8,10,19,24 The low clinical failure rates reported in the literature suggests that post-cone biopsy AIS eradication is the dominant process in most patients. In addition, the factors that impact post-cone biopsy eradication of AIS might be unrelated to the likelihood of whether a second de novo AIS neoplasm begins at the nSCJ.…”

“…3,4,[6][7][8]10,17,19 In contrast, 17% to 88% of hysterectomy specimens from hysterectomies performed soon after cone biopsy excision contain residual AIS. 4,7,8,10,11,14,15,18,20,21 Although it would seem logical to assume that conservatively treated patients with residual AIS would be at high risk of clinical failure, outcome studies have shown clearly that this assumption is false.…”

“…[1][2][3][4][5][6][7][8][9] Clinical failures of AIS or invasive adenocarcinoma following conservatively treated cone biopsy excision of AIS are infrequent. 3,7,8 In contrast, rates of residual AIS in hysterectomy specimens performed soon after a diagnostic cone biopsy are high. 2,4,[10][11][12][13][14][15][16][17][18] Reasons for this disparity are unknown.…”

Atypical Papanicolaou Smear in Pregnancy

“…43 Some warn against a potential risk of overtreatment and causing unnecessary stress in the patient if further treatment is based solely on the status of the cone margins. 48 Repeat conization might be warranted only if microinvasive disease or invasive carcinoma that would alter the timing of delivery were highly suspected. 49 With clear, unevaluable, or positive margins, long-term surveillance is warranted for cervical AIS.…”