Cervical Screening Results Leading to Detection of Adenocarcinoma in Situ of the Uterine Cervix

Document Type: Research Articles

Authors

Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang aMai, Thailand.

Abstract

Background: Adenocarcinoma in situ (AIS) of the uterine cervix is a preinvasive lesion of the invasive
adenocarcinoma. We analyzed the cervical screening results leading to detecting the AIS lesions including the coexistence
of AIS lesions with high-grade squamous intra-epithelial lesions (HSIL) and invasive carcinoma. Methods:
Women who were diagnosed and received treatment for AIS at Chiang Mai University Hospital between January 1,
2007 and August 31, 2016 were retrospectively reviewed. The inclusion criteria were the women who had pathological
diagnosis of AIS obtained from cervical punch biopsy or excisional cone biopsy with either loop electrosurgical excision
procedure (LEEP) or cold-knife conization (CKC). The patient characteristics, diagnostic work-up and treatment details
were reviewed, including the cervical screening results prior to the diagnosis of cervical AIS, pathologic results of
excisional cone biopsy and hysterectomy specimens. Results: During the study period, 75 women with AIS pathology
undergoing excisional cone biopsy with either LEEP (n=62) or CKC (n=13) were identified. The abnormal cytologic
screening leading to detection of AIS was the squamous cell abnormality accounting for 57.3%. Abnormal glandular
cytology accounted for 37.3%. The most common abnormal cervical screening results was HSIL cytology (n = 25)
followed by AIS cytology (n = 13). Normal cytology was noted in 4 women in whom 3 were positive for HPV 18
and 1 had AIS on the endocervical polyp. AIS coexisted with HSIL and invasive carcinoma were detected in cone
biopsy specimens in 21 (28%) and 29 (38.7%) patients, respectively. Conclusion: The majority of cervical screening
results leading to detection of cervical AIS was the squamous cell abnormality accounting for 57.3% in which, HSIL
cytology was the most common. Abnormal glandular cytology accounted for only 37.3%. Diagnostic cone excision is
recommended if AIS lesion is noted in cervical biopsy specimen since nearly 40% have coexisting invasive lesions.

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