title: Endocervical curettage at conization to predict residual cervical adenocarcinoma in situ.
abstract: OBJECTIVE
  To determine if performing an endocervical curettage (ECC) at the time of conization is a useful diagnostic tool for predicting residual cervical adenocarcinoma in situ (AIS) among women who might wish to preserve their fertility.
  
  
  METHODS
  All patients diagnosed with AIS from 1995 to 2000 at four institutions were identified. Data were retrospectively extracted from clinical records. Women included in the statistical analysis were (1) younger than 40 years, (2) had an ECC performed at the time of the initial cone biopsy, (3) had a clearly demarcated surgical margin pathologically, and (4) underwent a second surgical procedure.
  
  
  RESULTS
  Twenty-nine (24%) of 123 AIS patients met criteria for inclusion. The median age was 33 years (range, 17 to 39) and 13 (46%) were nulliparous. Initial surgery was a cold-knife conization (n = 17) or loop electrosurgical excision procedure (n = 12). Twelve (41%) ECCs and 15 (52%) cone margins were histologically positive. Sixteen patients underwent a repeat conization; 13 underwent hysterectomy. Thirteen (45%) patients had residual AIS at the time of their second surgical procedure. ECC had a superior positive predictive value (100% vs 47%; P < 0.01) and negative predictive value (94% vs 57%; P = 0.01) compared to cone margin in predicting residual AIS. None of the women undergoing fertility-sparing surgery developed recurrent AIS or adenocarcinoma.
  
  
  CONCLUSIONS
  ECC performed at the time of conization may be a useful tool for predicting residual AIS in women considering fertility preservation.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032, USA.
authors.forename: Jayanthi S
authors.initials: JS
authors.lastname: Lea
authors.forename: Christine H
authors.initials: CH
authors.lastname: Shin
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Sheets
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Linda R
authors.initials: LR
authors.lastname: Duska
authors.forename: David S
authors.initials: DS
authors.lastname: Miller
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D019092:Conization / Q000379:methods*; D003475:Curettage / Q000379:methods*; D005260:Female; D005298:Fertility; D006801:Humans; D018365:Neoplasm, Residual; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*