Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma-in-situ.

Abstract

BACKGROUND: Adenocarcinoma-in-situ (AIS) of the uterine cervix is a precursor to cervical adenocarcinoma and may co-exist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia (CIN) 2 and 3). Up to 60% of AIS lesions are detected incidentally following excisional biopsies performed for the treatment of CIN 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. OBJECTIVE: To investigate patient outcomes following incidentally detected cervical AIS after loop electrosurgical excision procedure (LEEP) or cold knife cone (CKC) biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia (CIN). STUDY DESIGN: A retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of AIS between 2001 and 2012. Primary outcomes were persistent or recurrent CIN 2/3 and or AIS, and invasive adenocarcinoma during follow-up (<12 months) and surveillance (=12 months) periods. RESULTS: The cohort comprised 298 patients, with 228 (76.5%) treated initially by LEEP and 70 (23.5%) treated by CKC biopsy. The mean age was 31.2 years (range 18 to 68 years) and the median length of follow-up was 2.4 years (range 0.3 to 12.2 years). Overall, 11 (3.7%) patients had CIN 2/3, 23 (7.7%) had AIS and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age over 30 years, pure AIS lesions and larger lesions (>8mm) were associated with a greater risk of disease persistence or recurrence. CONCLUSION(S): Following the incidental detection of AIS, age >30 years, pure AIS lesions and lesions >8mm, were significantly associated with disease persistence/recurrence. In younger women, incidentally detected AIS which co-exists with CIN 2/3 and is <8mm extent with clear margins may not require re-excision.