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Is electrosurgical loop excision with negative margins sufficient treatment for cervical ACIS?
P Bryson1, R Stulberg, L Shepherd
1Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, ON, Canada K7L 2V7. bryson@post.queensu.ca
Gynecologic Oncology
|April 22, 2004
Summary
Loop electrosurgical excisional procedure (LEEP) may be sufficient treatment for unexpected adenocarcinoma in situ of the cervix (ACIS) and endocervical glandular dysplasia (EGD). Conservative management with colposcopic follow-up is an option for patients with negative margins.
Area of Science:
- Gynecology
- Oncology
- Pathology
Background:
- Guidelines support conservative management for diagnosed cervical adenocarcinoma in situ (ACIS).
- ACIS can be unexpectedly found in loop electrosurgical excisional procedure (LEEP) specimens initially intended for squamous dysplasia.
- Outcomes for ACIS unexpectedly found in LEEP specimens require assessment.
Purpose of the Study:
- To evaluate if LEEP is sufficient treatment for patients with ACIS and endocervical glandular dysplasia (EGD) unexpectedly found in LEEP specimens.
- To determine appropriate management for this patient group.
Main Methods:
- Retrospective review of 60 patients treated for ACIS-EGD from 1990-2003.
- Analysis of LEEP specimens and subsequent follow-up data.
Main Results:
- Of 31 patients with ACIS-EGD in LEEP specimens, 28 were followed conservatively for a median of 42 months and remained disease-free.
- Seven patients with positive LEEP margins underwent further surgery (hysterectomy or cold knife cone biopsy) and were disease-free.
- Three patients were lost to follow-up.
Conclusions:
- Colposcopic follow-up with cytology and endocervical curettage (ECC) is acceptable for ACIS-EGD found unexpectedly in LEEP specimens with negative margins.
- This conservative approach offers an alternative to repeat LEEP, conization, or hysterectomy, preserving fertility.
- Positive margins necessitate further histologic evaluation.