title: Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ.
abstract: Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients.
  
  
  
  We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia.
  
  
  
  We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, and invasive adenocarcinoma during follow-up (<12 months) and surveillance (≥12 months) periods.
  
  
  
  The cohort comprised 298 patients, with 228 (76.5%) treated initially by loop electrosurgical excision procedure and 70 (23.5%) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7%) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence.
  
  
  
  Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.
authors.affiliation: Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia. Electronic address: aime.munro@nd.edu.au.
authors.forename: Aime
authors.initials: A
authors.lastname: Munro
authors.affiliation: Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Codde
authors.affiliation: Center for Population Health Research, Curtin University, Bentley, Australia.
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
authors.affiliation: Western Australia Cervical Cancer Prevention Program, Western Australia Health, Perth, Australia.
authors.forename: Nerida
authors.initials: N
authors.lastname: Steel
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Crawley, Australia.
authors.forename: Colin J R
authors.initials: CJ
authors.lastname: Stewart
authors.affiliation: St John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, Australia.
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Salfinger
authors.affiliation: St John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Tan
authors.affiliation: St John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, Australia.
authors.forename: Ganendra R
authors.initials: GR
authors.lastname: Mohan
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Crawley, Australia.
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Center for Population Health Research, Curtin University, Bentley, Australia.
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.affiliation: School of Health Sciences, Curtin University, Bentley, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: O'Leary
authors.affiliation: School of Biomedical Sciences, Curtin University, Bentley, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Williams
authors.affiliation: St John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Cohen
mesh_terms: D065311:Adenocarcinoma in Situ / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D002578:Uterine Cervical Dysplasia / Q000601:surgery*
keywords: cervical adenocarcinoma in situ; incidental AIS; lesion size; prognostic factors; risk factors