Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma-in-situ. — YRD
  1. Schedule
  2. Session 4: Proffered Papers
  3. Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma-in-situ.

Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma-in-situ. (3565)

Aime Munro 1 , Jim Codde 1 , Katrina Spilsbury 2 , Nerida Steel 3 , Colin JR Stewart 4 , Stuart G Salfinger 5 , Jason Tan 5 , Ganendra Raj Mohan 5 , Yee Leung 4 , James Semmens 2 , Peter O'Leary 2 , V Williams 6 , Paul A Cohen 7
  1. Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
  2. Centre for Population Health Research, Curtin University, Bentley, Western Australia, Australia
  3. WA Cervical Cancer Prevention Program, WA Health, Perth, Western Australia, Australia
  4. School of Women's and Infants' Health, University of Western Australia, Subiaco, Western Australia, Australia
  5. St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, Perth, Western Australia, Australia
  6. School of Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia
  7. St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia

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.