Fertility-sparing treatment in younger women with adenocarcinoma in situ of the cervix.
OBJECTIVE
For women who have completed childbearing, the treatment of choice for adenocarcinoma in situ (ACIS) of the cervix is hysterectomy. In women who desire future fertility, however, conservative therapy is an acceptable alternative. In this study we compare the outcomes for young women who underwent loop conization or were treated with cold knife conization.


METHODS
We performed a retrospective analysis in 112 patients with ACIS, age 30 or younger, treated with cold knife conization or loop conization between 1998 and 2010. Decision to perform office loop conization was based on the size of the cervix and the colposcopic lesion. Main outcomes were negative margins after the procedure and recurrence of ACIS.


RESULTS
Fifty-eight patients (52%) were treated with cold knife conization and 54 (48%) underwent loop conization. The odds ratio for cold knife conization to achieve negative cone margins compared with loop conization was 1.4 (95% CI 0.6-3.5). We observed no difference in residual or recurrent ACIS between patients treated with loop conization versus cold knife conization.


CONCLUSIONS
In select young patients who desire future fertility, loop conization and cold knife conization have equivalent rates of negative margins and negative follow-up. For optimal results, patients must have a lesion which can be removed in one pass of a loop, confirmed by expert colposcopy. Loop excision should be considered the treatment of choice in this specific group of patients.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Nehalennia
N
van Hanegem
Lisa M
LM
Barroilhet
Marisa R
MR
Nucci
Marilyn
M
Bernstein
Sarah
S
Feldman
D000230:Adenocarcinoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000601:surgery*; D015331:Cohort Studies; D019092:Conization / Q000379:methods; D003452:Cryosurgery / Q000379:methods; D004598:Electrosurgery / Q000379:methods; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D055815:Young Adult