Adenocarcinoma in situ and early invasive adenocarcinoma of the uterine cervix

As data continue to accumulate, the clinical characteristics of preinvasive and early invasive glandular cervical neoplasia are becoming progressively better defined. Cytologic screening for these lesions is imprecise; howeve r, modifications to current classification systems may improve the overall accuracy. All glandular abnormalities on the Papanicolaou smear, neverthele ss, require judicious evaluation and careful follow-up. Cervical conization is the most definitive means of diagnosing adenocarcinoma in situ (ACIS). Because ACIS has been thought to represent a multifocal process, with negat ive conization margins having limited predictive value, conservative manage ment protocols have been difficult to endorse. Several large studies now in dicate that the surgical margin status may be a more reliable indicator of true disease clearance than previously thought. For young patients desiring to maintain reproductive capacity, ACIS appears to be safely managed by co ld-knife conization combined with diligent surveillance. Early invasive ade nocarcinoma of the uterine cervix is associated with an excellent prognosis , and recent data suggest that radical surgery may be unnecessary. Curr Opi n Oncol 2001, 13:394-398 (C) 2001 Lippincott Williams & Wilkins, Inc.