ADENOCARCINOMA IN-SITU OF THE UTERINE CERVIX - MANAGEMENT AND OUTCOME

Objective: To retrospectively review the management of adenocarcinoma in situ of the uterine cervix, to determine the outcome of formation v ersus hysterectomy, and to compare the results achieved by different m ethods of conization. Methods: We performed a retrospective pathology and chair review of 46 patients with cervical adenocarcinoma in situ f rom January 1980 to October 1994. Results: Nine patients were managed during the first half of the study period and 37 were managed in the s econd half. The mean age of patients was 38.4 years (range 25-72). For ty-five of 46 patients were diagnosed as a result of an abnormal Pap s mear, although only 19 smears indicated adenocarcinoma in situ or othe r glandular abnormalities. told knife conization resulted in a 33% rat e of positive margins for adenocarcinoma in situ compared to 50% for l arge loop excision of the transformation zone (LLETZ). Among 24 conser vatively managed patients with negative conization margins, there have been 2 (8.3%) recurrences of adenocarcinoma in situ. Among patients n ot undergoing hysterectomy as definitive treatment, 1 of 18 (6%) patie nts undergoing cold knife conization recurred, compared to 4 of 14 (29 %) managed with LLETZ, despite a 63.4-month shorter mean follow-up int erval for the LLETZ patients, Conclusions: Cold knife conization is as sociated with a lower rate of recurrence of cervical adenocarcinoma in situ compared to LLETZ. We recommend cold knife conization for patien ts who are not treated with hysterectomy. (C) 1996 Academic Press, inc .