Adenocarcinoma in situ of the uterine cervix: management and outcome.
OBJECTIVE
To retrospectively review the management of adenocarcinoma in situ of the uterine cervix, to determine the outcome of conization versus hysterectomy, and to compare the results achieved by different methods of conization.


METHODS
We performed a retrospective pathology and chart review of 46 patients with cervical adenocarcinoma in situ from January 1980 to October 1994.


RESULTS
Nine patients were managed during the first half of the study period and 37 were managed in the second half. The mean age of patients was 38.4 years (range 25-72). Forty-five of 46 patients were diagnosed as a result of an abnormal Pap smear, although only 19 smears indicated adenocarcinoma in situ or other glandular abnormalities. Cold knife conization resulted in a 33% rate of positive margins for adenocarcinoma in situ compared to 50% for large loop excision of the transformation zone (LLETZ). Among 24 conservatively managed patients with negative conization margins, there have been 2 (8.3%) recurrences of adenocarcinoma in situ. Among patients not undergoing hysterectomy as definitive treatment, 1 of 18 (6%) patients undergoing cold knife conization recurred, compared to 4 of 14 (29%) managed with LLETZ, despite a 63.4-month shorter mean follow-up interval for the LLETZ patients.


CONCLUSIONS
Cold knife conization is associated with a lower rate of recurrence of cervical adenocarcinoma in situ compared to LLETZ. We recommend cold knife conization for patients who are not treated with hysterectomy.
Widrich
T
T
Department of Gynecology, Cleveland Clinic Foundation, Ohio 44195, USA.
Kennedy
A W
AW
Myers
T M
TM
Hart
W R
WR
Wirth
S
S
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D019092:Conization; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*