title: Adenocarcinoma in situ and early invasive adenocarcinoma of the uterine cervix.
abstract: 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; however, modifications to current classification systems may improve the overall accuracy. All glandular abnormalities on the Papanicolaou smear, nevertheless, 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 negative conization margins having limited predictive value, conservative management protocols have been difficult to endorse. Several large studies now indicate 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 cold-knife conization combined with diligent surveillance. Early invasive adenocarcinoma of the uterine cervix is associated with an excellent prognosis, and recent data suggest that radical surgery may be unnecessary.
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: S D
authors.initials: SD
authors.lastname: Shipman
authors.forename: R E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery*; D002471:Cell Transformation, Neoplastic; D019092:Conization; D005260:Female; D006801:Humans; D008403:Mass Screening; D009361:Neoplasm Invasiveness; D065006:Papanicolaou Test; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D014626:Vaginal Smears