Factors predicting the risk of residual disease in women conservatively treated for adenocarcinoma in situ of the cervix

C. Dragosloveanu, M. Moisa, R. Vlădăreanu

Rezumat: The purpose of this article is to assess the most recent data in literature regarding factors predicting the risk of residual disease in women treated by cervical conization for adenocarcinoma in situ of the uterine cervix. Adenocarcinoma in situ (AIS) of the cervix is a relatively rare histologic diagnosis; yet, in the last 40 years both incidence and mortality from adenocarcinoma have increased substantially in Europe and The United States. The management of AIS still represents a challenge to the health care provider and a subject of controversy in literature. Although histerectomy continues to be the treatment of choice for AIS in women who have completed child-bearing, AIS often occurs in women who wish to maintain their fertility (the average age at diagnosis being 35.8 years), hence the need for a conservative therapy requiring careful follow-up to minimize the risk of residual disease. Recent studies have tried to describe a predictive model of residual disease in women treated conservatively for AIS including conization margin status and endocervical curettage, with encouraging results. One of the major concerns regarding the conservative therapy for cervical AIS is the adequacy and accuracy of follow-up protocols; considering the potential for persistence and recurrence of glandular disease, the ASCCP and ACOG recommend to use a combination of cervical citology, HPV DNA tests, colposcopy with endocervical sampling every 6 months. Patients treated conservatively for cervical AIS need to be counseled regarding the potential risks of residual or recurrent disease despite negative screening results and also the importance of compliance with long-term follow-up ; combining the conization margin status with endocervical curettage gives the most statistically significant predictive model of residual disease.
Cuvinte cheie: AIS, conization, postresection margins, endocervical curettage, cervical invasive adenocarcinoma.