The Circumferential Extent of Disease Should Be Reported in Cervical Adenocarcinoma In Situ (AIS) Excised by LEEP and Cone Biopsies
A Plotkin, MA Khalifa, N Ismiil, RS Saad, V Dube, Z Ghorab, S Nofech-Mozes. University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
Background: Watchful surveillance following treatment with loop electrosurgical excision procedure (LEEP) or cone biopsy is an option for AIS patients interested in fertility preservation. In this study, we investigated several histopathologic characteristics as possible markers for residual/recurrent disease after initial surgical resection.
Design: Cases with cervical AIS or glandular dysplasia diagnosed on LEEP/cone procedure and accessioned between 2000 and 2008 were retrieved from the Department of Anatomic Pathology at Sunnybrook Health Sciences Centre. Cases were reviewed and the association between putative markers such as margin status, extent of disease (% of circumference), and multifocality and residual/recurrent was examined using 2 or Fisher exact test. Data regarding subsequent excision or follow up pap smears were collected from the medical records.
Results: We identified 59 cases of AIS (35 cone biopsies and 24 LEEP). AIS was the most advanced lesion in 47/59, microinvasive adenocarcinoma was identified in 4/59, microinvasive squamous cell carcinoma in 3/59 cases and glandular dysplasia in 5/59 cases. Follow up was available in 48 cases. Subsequent resection (n=10) revealed 4 residual AIS, 1 invasive adenocarcinoma, 1 squamous cell carcinoma and 4 no residual dysplasia. Of the remaining 38 cases followed up conservatively, 2 had evidence of disease on cytology. The likelihood of achieving negative margins was significantly associated with cone biopsy versus LEEP (23/35 vs. 9/24 p=0.0326). Residual/recurrent disease was significantly associated with positive margins (p=0.0115) and extent of 50% circumferential involvement (p=0.0028) but not with multifocality (p=1).
Conclusions: The extent of circumferential disease is a significant histopathologic marker for residual/recurrent disease and needs to be reported in addition to margin status. The higher risk associated with conservative treatment in patients with 50% circumferential involvement needs to be conveyed to the gynecologists to help in their treatment decision making.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 161, Monday Morning