Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ

Aime Munro, Jim Codde, Katrina Spilsbury, Nerida Steel, Colin J R Stewart, Stuart G. Salfinger, Jason Tan, Ganendra R. Mohan, Yee Leung, James B. Semmens, Peter O'Leary, Vincent Williams, Paul A. Cohen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. Objective We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. Study Design We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, 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 loop electrosurgical excision procedure and 70 (23.5%) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7%) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. Conclusion Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.

Original languageEnglish
Pages (from-to)272.e1-272.e7
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume216
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

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Cervical Intraepithelial Neoplasia
Neoplasms
Adenocarcinoma
Biopsy
Adenocarcinoma in Situ
Recurrence
Cervix Uteri
Cohort Studies
Therapeutics
Population

Cite this

Munro, Aime ; Codde, Jim ; Spilsbury, Katrina ; Steel, Nerida ; Stewart, Colin J R ; Salfinger, Stuart G. ; Tan, Jason ; Mohan, Ganendra R. ; Leung, Yee ; Semmens, James B. ; O'Leary, Peter ; Williams, Vincent ; Cohen, Paul A. / Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ. In: American Journal of Obstetrics and Gynecology. 2017 ; Vol. 216, No. 3. pp. 272.e1-272.e7.
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title = "Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ",
abstract = "Background Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60{\%} of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. Objective We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. Study Design We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, 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 loop electrosurgical excision procedure and 70 (23.5{\%}) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7{\%}) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7{\%}) had adenocarcinoma in situ, and 3 (1.0{\%}) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. Conclusion Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.",
keywords = "cervical adenocarcinoma in situ, incidental AIS, lesion size, prognostic factors, risk factors",
author = "Aime Munro and Jim Codde and Katrina Spilsbury and Nerida Steel and Stewart, {Colin J R} and Salfinger, {Stuart G.} and Jason Tan and Mohan, {Ganendra R.} and Yee Leung and Semmens, {James B.} and Peter O'Leary and Vincent Williams and Cohen, {Paul A.}",
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Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ. / Munro, Aime; Codde, Jim; Spilsbury, Katrina; Steel, Nerida; Stewart, Colin J R; Salfinger, Stuart G.; Tan, Jason; Mohan, Ganendra R.; Leung, Yee; Semmens, James B.; O'Leary, Peter; Williams, Vincent; Cohen, Paul A.

In: American Journal of Obstetrics and Gynecology, Vol. 216, No. 3, 01.03.2017, p. 272.e1-272.e7.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk of persistent and recurrent cervical neoplasia following incidentally detected adenocarcinoma in situ

AU - Munro, Aime

AU - Codde, Jim

AU - Spilsbury, Katrina

AU - Steel, Nerida

AU - Stewart, Colin J R

AU - Salfinger, Stuart G.

AU - Tan, Jason

AU - Mohan, Ganendra R.

AU - Leung, Yee

AU - Semmens, James B.

AU - O'Leary, Peter

AU - Williams, Vincent

AU - Cohen, Paul A.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. Objective We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. Study Design We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, 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 loop electrosurgical excision procedure and 70 (23.5%) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7%) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. Conclusion Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.

AB - Background Adenocarcinoma in situ of the uterine cervix is a precursor to cervical adenocarcinoma and may coexist with both adenocarcinoma and high-grade squamous dysplasia (cervical intraepithelial neoplasia 2 and 3). Up to 60% of adenocarcinoma in situ lesions are detected incidentally following excisional biopsies performed for the treatment of cervical intraepithelial neoplasia 2/3. To date there are no data regarding risk factors for persisting or progressive cervical neoplasia in these patients. Objective We sought to investigate patient outcomes following incidentally detected cervical adenocarcinoma in situ after loop electrosurgical excision procedure or cold knife cone biopsy performed for the treatment of high-grade cervical intraepithelial neoplasia. Study Design We conducted a retrospective, population-based cohort study of Western Australian patients with an incidental diagnosis of adenocarcinoma in situ from 2001 through 2012. Primary outcomes were persistent or recurrent cervical intraepithelial neoplasia 2/3 and or adenocarcinoma in situ, 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 loop electrosurgical excision procedure and 70 (23.5%) treated by cold knife cone biopsy. The mean age was 31.2 (range 18-68) years and the median length of follow-up was 2.4 (range 0.3-12.2) years. Overall, 11 (3.7%) patients had cervical intraepithelial neoplasia 2/3, 23 (7.7%) had adenocarcinoma in situ, and 3 (1.0%) had adenocarcinoma diagnosed during the follow-up and surveillance periods. Age >30 years, pure adenocarcinoma in situ lesions, and larger lesions (>8 mm) were associated with a greater risk of disease persistence or recurrence. Conclusion Following the incidental detection of adenocarcinoma in situ, age >30 years, pure adenocarcinoma in situ lesions, and lesions >8 mm were significantly associated with disease persistence/recurrence. In younger women, incidentally detected adenocarcinoma in situ that coexists with cervical intraepithelial neoplasia 2/3 and is <8 mm extent with clear margins may not require reexcision.

KW - cervical adenocarcinoma in situ

KW - incidental AIS

KW - lesion size

KW - prognostic factors

KW - risk factors

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U2 - 10.1016/j.ajog.2016.11.1044

DO - 10.1016/j.ajog.2016.11.1044

M3 - Article

VL - 216

SP - 272.e1-272.e7

JO - American Journal of Obstetrics & Gynecology

JF - American Journal of Obstetrics & Gynecology

SN - 0002-9378

IS - 3

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