Adenocarcinomain Situof the Uterine Cervix: Management and Outcome

Widrich, Theresa; Kennedy, Alexander W.; Myers, Teresa M.; Hart, William R.; Wirth, S.

doi:10.1006/gyno.1996.0147

Cited by 94 publications

(16 citation statements)

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“…Achieving negative margins is therefore recommended if conservative management is chosen. Similar to our findings, previous studies have shown that patients who undergo a LEEP are more likely to have positive margins than those who undergo CKC [4,5,16]. Kietpeerakool and colleagues [17] reported a higher incidence of positive margins in women who underwent a LEEP compared to CKC (56.8% vs. 26.1%).…”

Section: Discussionsupporting

confidence: 90%

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

Costales

Milbourne

Rhodes

et al. 2013

Gynecologic Oncology

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Objective Cervical 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. Methods The 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. Results The 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. Conclusion Patients 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.

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Section: Discussionsupporting

confidence: 90%

“…The finding of invasive adenocarcinoma on hysterectomy specimen following cone biopsy for AIS has been described [16,26,27]. Salani et al [8] reported that 3.5% of patients who were initially treated conservatively with conization and subsequently underwent a hysterectomy were found to have invasive adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

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

Costales

Milbourne

Rhodes

et al. 2013

Gynecologic Oncology

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“…This would be particularly applicable for glandular lesions, as they might not be as visible and accessible as squamous lesions with colposcopic methods, and the treatment for glandular precursor lesions might not be as satisfactory as for its squamous counterpart. [24][25][26] This could also partially explain the higher risk after AGC among women aged 30-39. Given that clinical assessment within six months in this age group was similar to that at other ages (appendix 1, table D), the higher risk might be the consequence of less aggressive assessment and treatment because of the desire to preserve fertility in this age group.…”

Section: Main Findings and Interpretationsmentioning

confidence: 99%

Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study

Wang

Andrae

Sundström

et al. 2016

BMJ

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ObjeCtivesTo investigate the risks of invasive cervical cancer after detection of atypical glandular cells (AGC) during cervical screening.Design Nationwide population based cohort study.setting Cancer and population registries in Sweden.PartiCiPants 3 054 328 women living in Sweden at any time between 1 January 1980 and 1 July 2011 who had any record of cervical cytological testing at ages 23-59. Of these, 2 899 968 women had normal cytology results at the first screening record. The first recorded abnormal result was atypical glandular cells (AGC) in 14 625, high grade squamous intraepithelial lesion (HSIL) in 65 633, and low grade squamous intraepithelial lesions (LSIL) in 244 168. Main OutCOMe MeasuresCumulative incidence of invasive cervical cancer over 15.5 years; proportion of invasive cervical cancer within six months of abnormality (prevalence); crude incidence rates for invasive cervical cancer over 0.5-15.5 years of follow-up; incidence rate ratios compared with women with normal cytology, estimated with Poisson regression adjusted for age and stratified by histopathology of cancer; distribution of clinical assessment within six months after the abnormality. resultsThe prevalence of cervical cancer was 1.4% for women with AGC, which was lower than for women with HSIL (2.5%) but higher than for women with LSIL (0.2%); adenocarcinoma accounted for 73.2% of the prevalent cases associated with AGC. The incidence rate of invasive cervical cancer after AGC was significantly higher than for women with normal results on cytology for up to 15.5 years and higher than HSIL and LSIL for up to 6.5 years. The incidence rate of adenocarcinoma was 61 times higher than for women with normal results on cytology in the first screening round after AGC, and remained nine times higher for up to 15.5 years. Incidence and prevalence of invasive cervical cancer was highest when AGC was found at ages 30-39. Only 54% of women with AGC underwent histology assessment within six months, much less than after HSIL (86%). Among women with histology assessment within six months, the incidence rate of cervical cancer after AGC was significantly higher than that after HSIL for up to 6.5 years.COnClusiOns AGC found at cervical screening is associated with a high and persistent risk of cervical cancer for up to 15 years, particularly for cervical adenocarcinoma and women with AGC at age 30-39. Compared with the reduction in risk of cancer seen after HSIL management, management of AGC seems to have been suboptimal in preventing cervical cancer. Research to optimise management is needed, and a more aggressive assessment strategy is warranted.

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“…Any strategy should aim to reduce the risk of invasive cancer while minimizing resulting morbidity. Suggested approaches to treatment range from radical hysterectomy and node dissection for all women( 2) to conservative management with conization of the cervix alone( 3).…”

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confidence: 99%

The management and follow-up of patients with high-grade cervical glandular intraepithelial neoplasia

Maini¹,

Lavie²,

Comerci³

et al. 1998

Int J Gynecol Cancer

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Maini M, Lavie O, Comerci G, Cross PA, Bolger B, Lopes A, Monaghan JM. The management and follow‐up of patients with high‐grade cervical glandular intraepithelial neoplasia. Int J Gynecol Cancer 1998; 8: 287–291. The purpose of this study was to evaluate if the status of the margins on large loop excision of the transformation zone (LLETZ) can predict the presence of residual cervical glandular intraepithelial neoplasia (CGIN) and to assess the efficacy of cervical conization as primary management of CGIN. Between January 1989 and March 1997 fifty patients with a diagnosis of CGIN made by LLETZ were treated in the Department of Gynaecological Oncology at the Queen Elizabeth Hospital, Gateshead. Presence or absence of CGIN at cone margins, results of cervical cytological examinations before and following conization, colposcopic examination, and results of histopathologic assessment of any surgical specimens taken after initial cone biopsy were analyzed in this study. Of the 50 patients with CGIN, managed by conization, in 34 (68%) CGIN was present at the surgical margins and in 16 (32%) the margins were clear. Eleven (32.3%) patients with CGIN at the margins of excision had evidence of residual disease and there was only one of the 16 (6.25%) patients with clear margins (P= 0.03). Two cases of invasive adenocarcinoma were identified in the group of patients with positive margins. In a mean follow‐up time of 32.35 months, no case of invasive carcinoma was identified in the completely excised group. In our retrospective study LLETZ was found to be an adequate primary management for CGIN, and the excision margin status of the LLETZ specimen did appear to be a prognostic factor for residual disease.

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Adenocarcinomain Situof the Uterine Cervix: Management and Outcome

Cited by 94 publications

References 0 publications

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

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

Risk of invasive cervical cancer after atypical glandular cells in cervical screening: nationwide cohort study

The management and follow-up of patients with high-grade cervical glandular intraepithelial neoplasia

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