Cervical Adenocarcinoma in Situ: Update and Management

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• Wright Jr TC, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol. 2007;197:340. The American Society for Colposcopy and Cervical Pathology, United States National Comprehensive Cancer Network, and American College of Obstetricians and Gynecologists published these consensus guidelines. Recommendations for diagnostic work up of patients with AGC and management of cervical AIS are provided.

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• Costa S, Venturoli S, Negri G, Sideri M, Preti M, Pesaresi M, et al. Factors predicting the outcome of conservatively treated adenocarcinoma in situ of the uterine cervix: an analysis of 166 cases. Gynecol Oncol. 2012;124:490–5. This study assessed the clinical long-term outcome of patients conservatively treated for cervical AIS and their predictive factors. Positive HPV test results were shown to be the strongest predictor for recurrence after conservative management of AIS.

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• van Hanegem N, Barroilhet LM, Nucci MR, Bernstein M, Feldman S. Fertility-sparing treatment in younger women with adenocarcinoma in situ of the cervix. Gynecol Oncol. 2012;124:72–7. This retrospective study investigated the effectiveness of loop versus cold knife conization in younger women (<30 years) with ACIS. The authors found no difference in achieving negative margins or recurrence of ACIS.

Kim ML, Hahn HS, Lim KT, Lee KH, Kim HS, Hong SR, et al. The safety of conization in the management of adenocarcinoma in situ of the uterine cervix. J Gynecol Oncol. 2011;22:25–31.

• El Masri WM, Walts AE, Chiang A, Walsh CS. Predictors of invasive adenocarcinoma after conization for cervical adenocarcinoma in situ. Gynecol Oncol. 2012;125:589–93. This retrospective study aimed to identify patients who can be safely managed with an extrafascial hysterectomy based on predictors of invasion in the conization specimen. Patients with features such as positive cone margins, positive endocervical sampling, and presence of pathological suspicion of invasion the conization specimen were at highest risk for invasive adenocarcinoma.

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Costa S, Negri G, Sideri M, Santini D, Martinelli G, Venturoli S, et al. Human papillomavirus (HPV) test and PAP smear as predictors of outcome in conservatively treated adenocarcinoma in situ (AIS) of the uterine cervix. Gynecol Oncol. 2007;106:170–6.

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Mahdi H, Thrall M, Agoff N, Doherty M. Pagetoid adenocarcinoma in situ of the cervix with pagetoid spread into the vagina. Obstet Gynecol. 2011;118:461–3.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112:1419–44.