Long-Term Surveillance Is Required for All Women Treated for Cervical Adenocarcinoma in situ

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One hundred patients with a diagnosis of cervical adenocarcinoma in situ (ACIS) or glandular dysplasia were identified in a retrospective chart review of all patients diagnosed within the 20 years from 1980 to 2000. The outcomes of patients whose primary treatment was hysterectomy were compared with those of patients who were treated more conservatively with local conization. Sixty-seven women who had cervical conization were followed conservatively over an average period of 59 months (median, 42 months; range, 1-222 months). Thirty-three patients who underwent hysterectomy had a mean follow up of 8 months (median, 80 months; range, 1-248 months). The women in the conservatively treated group were significantly younger than those in the hysterectomy group (average ages were 33.3 years and 40.1 years, respectively, P = 0.002); and they were more likely to be nulliparous (67% compared with 12%, P <0.0001). Nearly all patients (95 of 100) had an initial cone biopsy. Twenty of these were performed with a cold knife, 41 with laser, and 23 using an electrocautery loop. The type of cone was unknown in 11 patients. Histologic examination of the cone specimen found negative margins in 48.4% of patients and positive margins in 34.7%. No result could be determined in 16.8% of patients. Five women underwent hysterectomy based on cervical biopsy alone, 25 had hysterectomy after the cone biopsy, and 3 patients were treated with hysterectomy for recurrent ACIS. The type of cone biopsy did not influence the development of recurrent disease. Among the 67 women in the conservative group, 35 had negative margins in the cone biopsy specimen. None of these women developed a recurrence. Twenty women in the conservative group had positive margins in the initial cone biopsy. A second cone biopsy was performed in 11 of these women, 4 of whom had residual disease in the reexcision specimen. In the conservatively treated group, none of the patients whose initial cone biopsy showed positive margins and who also underwent a second cone biopsy developed a recurrence; but there were 3 recurrences among the 9 women with positive margins who received no further treatment. In the hysterectomy group, residual disease was found in the surgical specimen of 1 of 11 women who had negative cone biopsy margins, in 9 of 16 women with positive cone biopsy margins, and in 3 of 4 with indeterminate margins. All 4 women who underwent hysterectomy based on cervical biopsy alone had residual adenocarcinoma in situ in the hysterectomy specimen. There have been no recurrences in the group of patients who had negative margins on the initial cone biopsy, regardless of treatment. All of the 4 recurrences, 3 in the conservative group and 1 in the hysterectomy group, had positive margins on the first cone biopsy specimen.