Adenocarcinoma in situ of the cervix: Management and outcome

Objective. The aim of this study was to review the management and outcome o f patients with adenocarcinoma in situ of the cenix and to evaluate the sig nificance of endocervical cone margin status in these patients. Methods. A retrospective review of records between January 1988 and Decembe r 1996 identified 40 patients with adenocarcinoma in situ on cone biopsy fo r whom complete information was available. The median follow-up was 38 mont hs. Results. The mean age was 37 years, and the mean parity was 1.3. Fifty-thre e percent of the patients had prior abnormal cervical cytology. The initial Pap smear that led to the patient's referral was abnormal in 39 (98%). Ini tial cervical biopsies showed adenocarcinoma in situ and/or glandular dyspl asia in 28 (70%), squamous dysplasia in 2 (5%), chronic inflammation in 2 ( 5%), and no pathologic changes in 2 (5%) patients. Initially no biopsies we re performed in 3 (7.5%) patients and the results of 3 (7.5%) biopsies were unknown. Subsequently, all patients had cone biopsies. The endocervical ma rgins were positive for glandular abnormalities in 24% of cold knife cones (CKC), 75% of LEEPs, and 57% of laser cones. The ectocervical margins were positive for squamous and/or glandular abnormalities in 8% of CKCs, 13% of LEEPs, and 57% of laser cones. ECCs above the cone were obtained in 28 pati ents, and only 1 (3%) was positive. The definitive treatment was hysterecto my in 27, repeat cone in 5, and no additional therapy in 8 patients. The pa thology showed residual disease in 44% of treated patients. From 16 cone bi opsies with negative margins who had subsequent treatment, there was residu al disease in 5 (31%) specimens (1 adenocarcinoma in situ, 1 mild glandular dysplasia, 3 glandular atypia). From 16 cones with positive margins who ha d subsequent treatment, there was residual disease in 9 (56%) specimens. Th e patients with negative ECCs above the cone regardless of margin status ha d residual disease in 58% of treated specimens. Conclusion. Women with adenocarcinoma in situ of the uterine cenix had resi dual disease in 31% of cases with negative margins in cone biopsies and/or with negative ECCs and in 56% of cases with positive endocervical margins. LEEP cones had higher rate of positive endocervical margins (75%) compared to CKC (24%) and laser cone (57%). If maintaining reproductive capacity is desired, we would recommend CKC; however, this does not guarantee absence o f the disease. (C) 1999 Academic Press.