title: Management of adenocarcinoma in situ of the uterine cervix: a comparison of loop electrosurgical excision procedure and cold knife conization.
abstract: OBJECTIVE
  This study aimed to compare loop electrosurgical excision procedure (LEEP) with cold knife conization (CKC) as therapeutic management procedures for women with adenocarcinoma in situ (ACIS) of the cervix.
  
  
  METHODS
  We conducted a retrospective chart review of all patients who underwent a conization procedure with a preoperative or postoperative diagnosis of ACIS of the cervix from 1997 to 2011. Data gathered included demographics, risk factors, pretreatment Pap test and colposcopic biopsy results, conization pathology including presence of invasive cancer and margin status, subsequent need for reconization or hysterectomy, and follow-up. Outcome measures, such as diagnosis of invasive cancer, margin status, and recurrence of ACIS or development of invasive cancer, were compared between LEEP and CKC.
  
  
  RESULTS
  Of 115 conization procedures performed, 61 were LEEP (31 diagnostic and 30 therapeutic) and 54 were CKC (6 diagnostic and 48 therapeutic). Patients who underwent CKC were more often nulliparous, on oral contraceptive pills, and smoking cigarettes than patients who underwent LEEP. For the 78 patients who underwent conization procedures with therapeutic intent, there were no differences in the rates of positive margins (20% vs 17%), invasive cancer (3.3% vs 4.2%), recurrence of ACIS (6.7% vs 8.3%), or subsequent development of invasive adenocarcinoma (0 vs 2.0%) between LEEP and CKC, respectively.
  
  
  CONCLUSIONS
  In our study, LEEP was as good as CKC for the treatment of ACIS of the cervix, achieving the same rates of negative margins, diagnosis of invasive cancer, and recurrence of ACIS or invasive cancer. The benefits of LEEP versus CKC include the ability to perform the procedure in an outpatient clinic under local anesthesia with less morbidity. Patients treated for ACIS of the cervix by a conization procedure need careful, regular follow-up given the risk of recurrent ACIS or invasive cancer.
authors.affiliation: 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Nawar A
authors.initials: NA
authors.lastname: Latif
authors.forename: Nikki L
authors.initials: NL
authors.lastname: Neubauer
authors.forename: Irene B
authors.initials: IB
authors.lastname: Helenowski
authors.forename: John R
authors.initials: JR
authors.lastname: Lurain
mesh_terms: D065311:Adenocarcinoma in Situ / Q000175:diagnosis* / Q000601:surgery*; D000328:Adult; D000368:Aged; D019092:Conization / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult