Clinical Outcomes of Women with Adenocarcinoma in Situ of the Cervix Treated by Conization: An Integrated Literature Review

Abstract

Background: The incidence of cervical adenocarcinoma in situ is on the rise. Its detection, diagnosis, and management is both challenging and controversial. For these reasons, hysterectomy has historically been the treatment of choice, but many women with adenocarcinoma in situ are of reproductive age and have not completed childbearing so more conservative treatment is often desired.

Objectives: The purpose of the integrative literature review was to determine the efficacy and safety of conization as conservative treatment for women with cervical adenocarcinoma in situ wishing to preserve fertility, and to determine if one method of conization, cold knife cone or loop electrosurgical excisional procedure, is superior to the other in terms of outcome and residual or recurrent disease.

Methods: An integrative literature review was conducted to identify clinical outcomes of women with adenocarcinoma in situ of the cervix treated by conization. CINAHL and PubMed were used to gather sources from 1996 to 2015.

Results: There is inconsistent data regarding which method of conization is superior. Patients with positive resection margins (when adenocarcinoma in situ involvement is noted at the boundary of cervical conization specimen)are significantly more likely to have residual disease compared to those with negative margins (when involvement is within the cervical conization specimen).

Conclusions: Many clinicians still recommend hysterectomy, especially when positive margins are involved. The decision to go forward with fertility sparing surgery seems to be much more acceptable when the margins are negative. There needs to be more data regarding long-term follow-up of patients undergoing conservative treatment.

Key words: Adenocarcinoma in Situ, cervix, cone biopsy