Risk of persistent or recurrent neoplasia in conservatively treated women with cervical adenocarcinoma in situ with negative histological margins.
BACKGROUND
Conservative treatments including cold knife cone biopsy (CKC) or loop electrosurgical excision procedure (LEEP) are fertility-preserving alternatives to hysterectomy. The risks of persistent cervical neoplasia in women with negative surgical margins following conservative treatment of adenocarcinoma-in-situ (AIS) are uncertain. This study aims to investigate the risk of persistent or recurrent cervical neoplasia [AIS, adenocarcinoma and/or high-grade cervical squamous intraepithelial neoplasia (CIN)] and compliance with follow-up recommendations in conservatively treated women with AIS and negative histopathological margins.


METHODS
A retrospective, population-based study of Western Australian women treated by CKC or LEEP for AIS between 2001 and 2012. Histopathology reports were reviewed for demographic information, treatment procedures and clinicopathological factors. Primary outcomes were the diagnosis of cervical neoplasia during follow-up (defined as <12 months) and surveillance (≥12 months) periods.


RESULTS
The cohort comprised 360 women, with 175 (48.6%) initially treated by CKC and 185 (51.4%) treated by LEEP. The median patient age at time of excisional treatment was 30.0 years (range 18-64 years) and the median follow-up time was 3.9 years (range six months to 12.2 years). During the follow-up and surveillance periods, seven (1.9%) women were diagnosed with CIN 2/3, 10 (2.8%) with AIS, and one (0.3%) with cervical adenocarcinoma, despite their initial excision specimens having negative histological margins.


CONCLUSIONS
In this study, there was a low but significant risk of persistent or recurrent cervical neoplasia in women who had initial conservative management of AIS with negative histopathological margins.
Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
Aime
A
Munro
Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
Jim
http://orcid.org/0000-0001-7924-1357
J
Codde
Center for Population Health Research, Curtin University, Bentley, WA, Australia.
Katrina
http://orcid.org/0000-0002-7434-2957
K
Spilsbury
School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.
Colin J R
CJ
Stewart
WA Cervical Cancer Prevention Program, WA Health, Perth, WA, Australia.
Nerida
http://orcid.org/0000-0002-6601-7310
N
Steel
School of Women's and Infants' Health, University of Western Australia, Crawley, WA, Australia.
Yee
http://orcid.org/0000-0003-0349-8652
Y
Leung
St. John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, WA, Australia.
Jason
J
Tan
St. John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, WA, Australia.
Stuart G
SG
Salfinger
St. John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, WA, Australia.
Ganendra R
GR
Mohan
Center for Population Health Research, Curtin University, Bentley, WA, Australia.
James B
http://orcid.org/0000-0003-2744-1394
JB
Semmens
St. John of God Hospital Bendat Family Comprehensive Cancer Center, Subiaco, WA, Australia.
Paul A
PA
Cohen
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D019092:Conization; D003452:Cryosurgery; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult
Cervical neoplasia; adenocarcinoma-in-situ; cold knife cone biopsy; loop electrosurgical excision procedure; women