title: Conservative Treatment Seems the Best Choice in Adenocarcinoma In Situ of the Cervix Uteri.
abstract: OBJECTIVE
  To study diagnostic and therapeutic strategies, outcomes, and follow-up in a large series of women with adenocarcinoma in situ (AIS) of the uterine cervix and investigate if human papillomavirus (HPV) typing among women with negative cytology reports would have helped with early AIS detection.
  
  
  METHODS
  Records of 132 AIS cases diagnosed between 1989 and 2012 were retrieved. Clinical and pathological data were reviewed and analyzed.
  
  
  RESULTS
  Mean age at diagnosis was 37 years. Seventy-two percent (n = 95) of all patients were asymptomatic; diagnosis was established using cytology and biopsy. Primary treatment for 124 patents was cold knife cone or loop electrosurgical excision procedure (LEEP). Positive margins were found in 18% of those women treated with CKC versus 40% in those treated with LEEP. The mean follow-up time was 62 months (range, 2-217 months; median, 46 months). Three recurrences were found after conservative treatment in 86 patients. High-risk HPV (hrHPV) positivity was detected in 115 (96%) of 120 patients, with HPV-18 being the most commonly occurring subtype (51%).
  
  
  CONCLUSIONS
  There is a small risk of relapse after conservative therapy with cold knife cone or LEEP when resection margins are negative in women with AIS. Patients should be given the options of hysterectomy or conservative therapy with strict follow-up.
authors.affiliation: 1Reinier de Graaf Hospital, Department of Obstetrics and Gynecology, Delft; 2DDL Diagnostic Laboratory, Rijswijk; 3Reinier de Graaf Hospital, Department of Pathology, Delft; and 4Erasmus MC University Medical Center, Department of Obstetrics and Gynecology, Rotterdam, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: Baalbergen
authors.forename: Anco C
authors.initials: AC
authors.lastname: Molijn
authors.forename: Wim G V
authors.initials: WG
authors.lastname: Quint
authors.forename: Frank
authors.initials: F
authors.lastname: Smedts
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Helmerhorst
mesh_terms: D065311:Adenocarcinoma in Situ / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D052161:Human papillomavirus 18 / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000175:diagnosis / Q000453:epidemiology; D012042:Registries; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016387:Women's Health