Cervical conization of adenocarcinoma in situ: a predicting model of residual disease

Background: Adenocarcinoma in situ (AIS) of the cervix, is increasing in incidence, particularly in women of reproductive age. Fertility preservation is often desired. In a predominantly Hispanic population, we sought to determine the incidence of occult cervical cancer co-existing with AIS, and evaluate how conization margin status correlates with residual disease upon hysterectomy. Methods: A retrospective study utilizing a comprehensive cancer center database was conducted. Data from patients with histologically proven AIS of the cervix were abstracted. Results: Of 47 patients that met the criteria, 23 (49%) were Hispanic, 21 (45%) were White, two (4%) were Asian, and one (2%) was Black. The median age was 37. Forty-two patients underwent cervical conizations; 13/42 (48%) had positive margins upon conization; 28/42 (67%) underwent hysterectomies. Furthermore, 6/13 (46%) patients with positive conization margins had residual disease in hysterectomy specimens, with 2/13 (15%) found to have invasive cancer. In contrast, 0/14 (0%) of patients with negative margins had residual disease (p = 0.036, Chi-squared 4.41, df = 1). In total, 2/27 (7%) patients who underwent hysterectomies had invasive cancer (7%). Conclusions: Positive margins upon cervical conization for AIS of the cervix were correlated with a relatively high rate of residual AIS and occult invasive cancer. Negative conization margins were correlated with no residual disease. Those patients may be candidates for fertility-sparing treatment.

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Margin status post cervical conization predicts residual adenocarcinoma in situ and occult adenocarcinoma

Gynecologic Oncology ◽

10.1016/s0090-8258(21)01038-6 ◽

2021 ◽

Vol 162 ◽

pp. S203-S204

Author(s):

Linda Hong ◽

Sandy Huynh ◽

Joy Kim ◽

Laura Denham ◽

Yevgeniya Ioffe

Keyword(s):

Margin Status ◽

Adenocarcinoma In Situ ◽

Cervical Conization

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Effect of treatment choices for cervical adenocarcinoma in situ on rates of residual disease, recurrence and progression

Southern African Journal of Gynaecological Oncology ◽

10.1080/20742835.2017.1402434 ◽

2017 ◽

Vol 9 (2) ◽

pp. 30-34

Author(s):

Johanna Theuws ◽

David G. Allen

Keyword(s):

Residual Disease ◽

Disease Recurrence ◽

Cervical Adenocarcinoma ◽

Adenocarcinoma In Situ ◽

Treatment Choices ◽

Effect Of Treatment

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Risk of residual disease and invasive carcinoma in women treated for adenocarcinoma in situ of the cervix

Gynecologic Oncology ◽

10.1016/j.ygyno.2013.03.015 ◽

2013 ◽

Vol 129 (3) ◽

pp. 513-516 ◽

Cited By ~ 19

Author(s):

Anthony B. Costales ◽

Andrea M. Milbourne ◽

Helen E. Rhodes ◽

Mark F. Munsell ◽

John J. Wallbillich ◽

...

Keyword(s):

Invasive Carcinoma ◽

Residual Disease ◽

Adenocarcinoma In Situ

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The value of MR-based radiomics in identifying residual disease in patients with carcinoma in situ after cervical conization

Scientific Reports ◽

10.1038/s41598-020-76853-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Mengfan Song ◽

Jing Lin ◽

Fuzhen Song ◽

Dan Wu ◽

Zhaoxia Qian

Keyword(s):

High Risk ◽

Carcinoma In Situ ◽

Residual Disease ◽

Disease Free Survival ◽

Risk Groups ◽

Uterine Preservation ◽

Imaging Model ◽

Kaplan Meier ◽

Cervical Conization

AbstractCarcinoma in situ (CIS) of the uterine cervix is a precursor to cervical carcinoma. However, hysterectomy can be avoided in patients who can be treated by cone biopsy. Previous studies have shown that imaging-based approaches allow for the noninvasive visualization of cervical cancer, and radiomics has high accuracy in classifying cancer and predicting treatment outcome for different cancer types. To develop a magnetic resonance (MR)-based radiomics model for identifying residual disease in patients with CIS after cervical conization. Patients who had CIS after conization and finally underwent hysterectomy were collected to comprise a database to establish an imaging model for predicting the residual status after conization. Then, patients who opted for uterine preservation were classified as high-risk or low-risk patients according to the model. The disease-free survival was compared between the different risk groups using the Kaplan–Meier curve. The model built with the Boruta features outperformed the random forest model. Further validation with patients with uterine preservation showed that the patients classified as high risk were more likely to have tumor recurrence/residual disease in the follow-up period. In conclusion, radiomics can be used to identify residual disease in patients with CIS after cervical conization and could have the potential to predict recurrence in patients who opt for uterine preservation.

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Case Report About Extraperitoneal Metastasis of Cervical Adenocarcinoma In Situ

10.21203/rs.3.rs-956313/v1 ◽

2021 ◽

Author(s):

Aiwen Le ◽

Lirong Han ◽

Peng Wang ◽

Kai Kang

Keyword(s):

Intraepithelial Neoplasia ◽

Adenocarcinoma In Situ ◽

Retroperitoneal Mass ◽

Cancer Antigen 125 ◽

Case Presentation ◽

Cin Iii ◽

Mucinous Epithelium ◽

Missed Diagnosis ◽

Cervical Conization

Abstract Background: adenocarcinoma in situ(AIS) cells are often misdiagnosed, and recognizing AIS in cervical cytology is challenging. Here, we present a case of extraperitoneal metastasis 5 years after a missed diagnosis of AIS.Case presentation: We report a 49-year-old Chinese woman who presented with a retroperitoneal mass 5 years after cervical conization for AIS. The retroperitoneal mass was composed of glands lined by malignant mucinous epithelium; these tumors were metastases from her previous AIS which were misdiagonised cervical intraepithelial neoplasia(CIN) III in 2013. The patient is alive and well 2 years after resection of the tumors.Conclusions: An experienced pathologist or multiple pathologists should take part in endocervical AIS diagnosis. We should follow these patients for over 15 years. When Cancer Antigen 125(CA125) or Carcinoembryonic antigen(CEA) levels are elevated, the occurrence of metastases should be strictly monitored.

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Prevalence, Predictive Factors and Nomogram of Residual Disease Following Cervical Conization for Adenocarcinoma in Situ

Asian Pacific Journal of Cancer Care ◽

10.31557/apjcc.2021.6.3.317-322 ◽

2021 ◽

Vol 6 (3) ◽

pp. 317-322

Author(s):

Boonyapipat Sathana ◽

Sukkasame Pichamon

Keyword(s):

Multivariate Analysis ◽

Predictive Factors ◽

Residual Disease ◽

Statistical Significance ◽

Individual Risk ◽

Management Decision ◽

P Value ◽

Adenocarcinoma In Situ ◽

Invasive Adenocarcinoma

Objectives: To evaluate the prevalence of residual disease after conization in AIS women, and to develop a nomogram for predicting residual disease in such patients. Methods: Eighty-three cervical adenocarcinoma in situ (AIS) patients were retrospectively reviewed. Patient data concerning: demographic characteristics, colposcopic findings and diagnosis, type of conization, size of pathologic specimens, pathological characteristics, endocervical curettage (ECC) pathology and subsequent procedures, were collected. The rate of residual disease after conization and predictive factors for residual disease in subsequent hysterectomy were analyzed, and a predictive nomogram for residual disease was developed, based on the multivariate analysis results. The statistical significance was set at a p-value of <0.05.Results: The prevalence of residual disease in hysterectomy specimens following conization was 31.8%. Five (5.7%) women with AIS, who underwent subsequent hysterectomy, were found to have invasive adenocarcinoma. According to the multivariate analysis results, the predictive factors for residual disease were a positive endocervical margin status [OR 22.5 (95% CI 4.74, 106.79)] and a depth of specimen of < 8 mm [OR 8.11 (95% CI 1.12, 58.95)]. A nomogram for the prediction of residual disease in AIS women was developed, based on these predictive factors. After bootstrapping 1000 times, the bootstrap-corrected concordance index value for predicting residual disease was 0.852. Conclusion: The residual disease was found in 31.8% of hysterectomy specimens after conization for AIS. Residual disease was strongly associated with a positive endocervical margin and a depth of specimen of <8 mm. This study reports a feasible nomogram, with an acceptable level of accuracy for predicting the individual risk of residual disease; which may be beneficial in proper management decision-making.

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