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

Abstract

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