IS LOOP EXCISION ADEQUATE PRIMARY MANAGEMENT OF ADENOCARCINOMA IN-SITU OF THE CERVIX

Objective To assess the efficacy of cervical loop excision as primary management of adenocarcinoma in situ. Design A two-centre retrospectiv e study. Setting Birmingham and Midlands Hospital for Women and City H ospital NHS Trust. Population Nineteen women with a histological diagn osis of adenocarcinoma in situ (high grade CIGN) of the cervix made on diathermy loop excision. Main outcome measures Presence or absence of adenocarcinoma in situ at loop specimen margins, results of cervical cytological examinations following loop excision, results of histopath ological assessment of any surgical specimens taken after initial loop excision. Results Of the 19 women with confirmed adenocarcinoma in si tu on loop excision, the median age was 31, and 8 (42%) were nulliparo us. The median follow up of these women was 19 months. Eleven women we re treated by loop excision alone and have had normal follow up to 18 months. Five women have undergone further surgical procedures, four ha d a hysterectomy and one had a repeat loop excision. No residual disea se was found in any of these surgical specimens, confirming that loop excision was adequate primary management of the disease. Three women h ave had abnormal endocervical follow up cytology suggestive of residua l disease. One of these three women may represent a case of residual e ndocervical disease. Excision margins of the loop specimen were not in volved by adenocarcinoma in situ in 11 women. However, excision margin status of the loop specimen did not appear to be predictive of residu al disease. Conclusions Our small retrospective study suggests that di athermy loop excision of the cervix is adequate primary management of adenocarcinoma in situ of the cervix. Cytological and colposcopic foll ow up, including cytobrush endocervical cytological sampling and long term follow up, is recommended in these women.