ENDOCERVICAL CURETTAGE, CONE MARGINS, AND RESIDUAL ADENOCARCINOMA IN-SITU OF THE CERVIX

Objective: To evaluate endocervical curettage (ECC) and cone margin in volvement in the management of adenocarcinoma in situ of the cervix. M ethods: Forty-two women with adenocarcinoma in situ without any associ ated invasive component underwent 49 cervical conizations. The ECC, co ne margin involvement, and residual endocervical glandular disease wer e evaluated in a retrospective descriptive study. Results: The patient s ranged from 18 to 65 years old, with a median of 34 years and a mean of 37 years. Nineteen of 42 (45%) of the women presented with initial cervicovaginal cytology suggesting endocervical glandular abnormality . Twenty-seven patients (64%) had mixed lesions of adenocarcinoma in s itu and squamous dysplasia noted in their cervical biopsy, conization, or hysterectomy specimens. Forty ECCs were performed at colposcopy or immediately after conization; 28 patients with ECCs subsequently unde rwent conization, and 12 underwent hysterectomy. Residual adenocarcino ma in situ was found in 18 (67%) of the 27 patients with negative ECCs and in ten of 13 women with positive ECCs. Residual adenocarcinoma in situ was found in two of seven patients with negative cone margins an d seven of ten patients with positive margins. Conclusion: We found th at negative ECCs and uninvolved cone margins in patients with cervical adenocarcinoma in situ were not reassuring of the absence of residual endocervical glandular disease in subsequent surgical specimens. Cons ervative management and subsequent surveillance of adenocarcinoma in s itu should be undertaken with caution. (C) 1997 by The American Colleg e of Obstetricians and Gynecologists.