Adenocarcinoma in situ of the cervix

Objective: To retrospectively review the management of adenocarcinoma in situ (AIS) of the uterine cervix. Methods: Forty-eight patients diagnosed with AIS of the cervix between March 1990 and March 1999 were identified. Results: Mean age of patients was 35.8 years (range 17–72). Cold knife conization resulted in a 28% rate of positive margins for AIS compared with 70% for large loop excision of the transformation zone (LLETZ). Fifteen of 39 conizations (37%) had AIS with negative margins of resection. Two of the 15 (13%) were treated with hysterectomy and 1 with repeat conization; none of the surgical specimens had residual AIS. Among 12 conservatively managed patients with negative conization margins, there was one recurrence (7%) of AIS. Eighteen of the 39 conizations (46%) had margins positive for AIS; 3 (8%) were positive for adenocarcinoma and 1 was positive for adenosquamous carcinoma. Twelve of the 18 (67%) were treated with hysterectomy and 6 of the 18 (33%) with repeat conization. Two of the 12 (17%) hysterectomy specimens and 1 of the repeat conization specimens contained residual AIS; 3 hysterectomy specimens (25%) contained cervical adenocarcinoma. Conclusion: This is the largest series of patients diagnosed with AIS to date. We found a significantly lower rate of positive margins with cold knife conization than with LLETZ. Among the conservatively managed patients with negative conization margins, there was one recurrence of AIS.