Management of Atypical Glandular Cells and Adenocarcinoma in Situ

Dunton, Charles J.

doi:10.1016/j.ogc.2008.09.002

Cited by 14 publications

(15 citation statements)

References 47 publications

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“…However, many reports have shown conservative management with cervical conisation to be safe and effective in women who desire future fertility provided negative margins are obtained. [1][2][3]11 Salani et al performed a meta-analysis of 33 studies, which included a total of 1,278 patients with AIS. 2 They noted that a positive conisation margin was associated with a significant risk of residual disease (odds ratio [OR]=4.01) and of recurrent disease (OR=2.48).…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…1 It usually affects women of childbearing age in which a more conservative approach is preferred. [1][2][3] The incidence of both AIS and adenocarcinoma of the cervix has been increasing, especially among young women. 4,5 Cervical conisation, or cone biopsy, can be performed using a scalpel (cold knife cone [CKC]), laser, or electrosurgery (loop electrosurgical excision procedure [LEEP]).…”

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confidence: 99%

“…1 However, the treatment can be challenging in women with AIS where the lesions are often located high in the endocervical canal, and may be multifocal. Repeat conisations are often required until negative margins are obtained.…”

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confidence: 99%

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Adenocarcinoma in situ of the Cervix – is Loop Electrosurgical Excision Procedure an Acceptable Alternative to Cold Knife Cone Biopsy?

Salcedo

Costales

Munsell

et al. 2017

European Oncology &Amp; Haematology

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O bjective: To compare cone specimen size between loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC), and evaluate the association between specimen size and margin status. Methods/materials: A retrospective review was performed of women with adenocarcinoma in situ (AIS) who underwent CKC or LEEP between 1998 and 2013. Specimen size, including length (distance from the external cervical os to the endocervical margin) and volume were compared between LEEP and CKC, and correlated with margin status. Results: Eighty-five patients underwent a total of 136 procedures, including 91 CKCs (67%) and 45 LEEPs (33%), with 27 removed as a single specimen (one-piece LEEP) and 18 as two specimens with an ectocervical specimen and a deeper endocervical tophat specimen (two-piece LEEP). The two-piece LEEP specimen median length was significantly longer (2.1 cm) versus CKC (1.4 cm, p<0.01) and one-piece LEEP (0.6 cm, p<0.01). Median specimen volume was greater for two-piece LEEP (7.4 cm 3 ) versus CKC (3.4 cm 3 , p<0.01) and one-piece LEEP (1.6 cm 3 , p<0.01). A higher rate of positive margins was noted when comparing all LEEP (67.6%) with CKC specimens (34.2%), p<0.01. However, when the LEEP specimens were analysed separately, one-piece LEEPs had a higher rate of positive margins (81.0%) versus CKC (34.2%) (p<0.01), but there were no significant differences between two-piece LEEP (50.0%) and CKC (34.2%), p=0.26. Conclusion: Our results suggest that a two-piece LEEP produces a larger specimen size with similar rates of positive margins compared with CKC. Given the decreased cost and morbidity compared with CKC, a two-piece LEEP should be considered in the management of women with AIS. Keywords Compliance with Ethics:This study involves a retrospective review and did not involve any studies with human or animal subjects performed by any of the authors. Institutional Review Board approval was obtained with a waiver of informed consent.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Cervical adenocarcinoma in situ (AIS) is recognised as a premalignant glandular condition and is a precursor to invasive cervical adenocarcinoma.1 It usually affects women of childbearing age in which a more conservative approach is preferred.1-3 The incidence of both AIS and adenocarcinoma of the cervix has been increasing, especially among young women.4,5 Cervical conisation, or cone biopsy, can be performed using a scalpel (cold knife cone [CKC]), laser, or electrosurgery (loop electrosurgical excision procedure [LEEP]). For patients with squamous dysplasia (cervical...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Adenocarcinoma in situ of the Cervix – is Loop Electrosurgical Excision Procedure an Acceptable Alternative to Cold Knife Cone Biopsy?

Salcedo

Costales

Munsell

et al. 2017

European Oncology &Amp; Haematology

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“…The diagnosis is based on architectural and nuclear criteria. In women with atypical glandular cell cytology (ATC), the risk of a high grade squamous or glandular lesion is over 30% [28].…”

Section: Forms Of Hpv Infection Observedmentioning

confidence: 99%

Human Papilloma Virus (HPV) and Genital Cancer

Rodríguez-Cerdeira¹,

Alcántara²,

Guerra‐Tapia³

et al. 2009

TODJ

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Epidemiological relationships were established more than 100 years ago between precursory lesions of cervical cancer and risky sexual behaviour. For various decades medicine has, unsuccessfully, tried to find the relationships between the agents responsible for sexually transmitted infections with this neoplasia.Thus, epidemiological studies supported by liquid cytological and molecular techniques have confirmed the role of certain strains of human papilloma virus (HPV) in the development of cervical, vulvar and vaginal cancer. It has been shown that, in an international series using high PCR, 90.7% of cervical-uterine carcinomas have DNA from HPV, and, 100% of the cases have been confirmed with exhaustive histological examinations, and in the majority of the intraepithelial lesions of the lower genital tract.Persistent infection with high-risk HPV-types is associated with genital cancers. Smoking and HIV infection have consistently been associated with longer duration of HPV infection and risk for genital cancer.We present the most important clinical manifestations of HPV infection within the spectrum of epithelial anomalies, considered as precursors or pre-colonizers of genital cancer and an update of their possible treatments.

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Adherence to practice guidelines for atypical glandular cells on cervical cytology

Sharpless

King

Schnatz

2012

Cancer Cytopathology

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BACKGROUND: Atypical glandular cells (AGC) on cervical cytology are high–risk, requiring an extensive evaluation. Compliance with practice guidelines for AGC, however, has been low. Some AGC cytology reports contain cytopathologist recommendations for evaluation. This study determines whether evaluation rates for AGC have improved over time, and whether cytopathologists' recommendations correlate with the types of evaluation women receive. METHODS: Evaluation rates from 284 women with AGC (2004‐2007) were compared with findings from 1998‐2001. Rates of evaluations were compared based on cytology report recommendations. RESULTS: A total of 76.1% of the AGC cases had histologic sampling, and 58.8% had a comprehensive evaluation. These rates are higher than those from 1998‐2001 (63.5% and 35.8%, respectively; P<.01). Rates of evaluations of women with AGC “favor neoplasia” did not increase between the 2 time periods. Between 2004‐2005 and 2006‐2007, rates of comprehensive initial evaluations and endometrial sampling in women ≥35 years of age did not increase. Of the AGC reports that did contain cytopathologist recommendations, 28% were consistent with practice guidelines, 26% recommended an incomplete histologic evaluation, and 46% recommended repeat cytology. Women whose AGC report recommended a comprehensive evaluation or any histologic evaluation were more likely to have a comprehensive work–up (79%) than those whose reports did not contain recommendations (55%, P <0.01) or recommended repeat cytology (51%, P<0.02). CONCLUSIONS: Adherence to practice guidelines for the evaluation of women with AGC has improved but continues to be suboptimal. Our findings suggest that continuing education and including practice guidelines on AGC cytology reports may improve compliance. Cancer (Cancer Cytopathol) 2013;121:47–53 © 2012 American Cancer Society.

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Management of Atypical Glandular Cells and Adenocarcinoma in Situ

Cited by 14 publications

References 47 publications

Adenocarcinoma in situ of the Cervix – is Loop Electrosurgical Excision Procedure an Acceptable Alternative to Cold Knife Cone Biopsy?

Adenocarcinoma in situ of the Cervix – is Loop Electrosurgical Excision Procedure an Acceptable Alternative to Cold Knife Cone Biopsy?

Human Papilloma Virus (HPV) and Genital Cancer

Adherence to practice guidelines for atypical glandular cells on cervical cytology

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