‘Pure’ adenocarcinoma-in-situ of cervix vs. adenocarcinoma-in-situ mixed with high grade cervical neoplasia: does the distinction matter? — YRD
  1. Schedule
  2. Session 4: Proffered Papers
  3. ‘Pure’ adenocarcinoma-in-situ of cervix vs. adenocarcinoma-in-situ mixed with high grade cervical neoplasia: does the distinction matter?

‘Pure’ adenocarcinoma-in-situ of cervix vs. adenocarcinoma-in-situ mixed with high grade cervical neoplasia: does the distinction matter? (3586)

Elizabeth Codde 1 , Aime Munro 2 , Shirley Bowen 1 , Jim Codde 2 , Nerida Steel 3 , Colin Stewart 4 , Katrina Spilsbury 5 , Yee Leung 4 , Ganendra R. Mohan 6 , Stuart G. Salfinger 6 , Jason Tan 6 , James B. Semmens 5 , Peter O’Leary 7 , Vincent Williams 8 , Paul Cohen 6
  1. School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
  2. Institute for Health Research, University of Notre Dame, Fremantle, WA, 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, Crawley, Western Australia, Australia
  5. Centre for Population Health Research, Curtin University, Bentley, Western Australia, Australia
  6. Bendat Family Comprehensive Cancer Centre, St John of God Hospital , Subiaco, Western Australia, Australia
  7. School of Health Sciences, Curtin University, Bentley, Western Australia, Australia
  8. School of Biomedical Sciences, Curtin University, Bentley, Western Australia, Australia

Background:

Cervical adenocarcinoma-in-situ (AIS) may co-exist with high-grade squamous dysplasia (CIN2/3) or occur as a pure lesion. Outcome data comparing ‘pure AIS’ and ‘mixed AIS’ are limited.

 

Objective:

To compare risks of disease persistence, recurrence and progression to invasive cancer) between ‘pure AIS’ and ‘mixed AIS’ (AIS + CIN2/3).

 

Study design:

A retrospective, population-based cohort study of Western Australian women diagnosed with AIS between 2001 and 2012. Patients with a prior history of high-grade cervical neoplasia, malignancy or hysterectomy as the initial treatment, were excluded. De-identified linked datasets were utilised to ascertain patient age at treatment, pathological margin status, lesion type (pure AIS or a mixed AIS lesion), lesion size, and cases of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post treatment), and invasive adenocarcinoma.

 

Results:

Six hundred thirty-six patients were eligible for analysis. The mean age was 32.3 years (range 18 to 76 years) and median follow-up interval was 2.5 years (range 0.2 months to 12 years). Within the study cohort, 266 (41.8%) patients were diagnosed with ‘pure AIS’ and 370 (58.2%) with ‘mixed AIS’ (AIS and CIN2/3). Overall, 49 (7.7%) patients had ACIS persistence/recurrence, while 11 (1.7%) were diagnosed with adenocarcinoma during follow-up. No patient died of cervical cancer within the study period. Factors associated with disease persistence or recurrence were ‘pure AIS’ (HR 2.3), age <30 years (HR 0.5), , positive endocervical margins (HR 5.4) and AIS lesions >8mm (HR 3.6). Positive ectocervical margin involvement was not associated with persistent/recurrent disease.

 

Conclusions:

In this study, pure AIS was associated with a higher risk of persistent or recurrent disease compared to mixed AIS. AIS lesions >8mm and positive endocervical margins were also significant predictors for persistent or recurrent disease.