[Clinical observational study on detection and treatment of adenocarcinoma in situ of the cervix].

Abstract

Objective: To investigate the related factors of residual cervical adenocarcinoma in situ (AIS) or cervical adenocarcinoma (CAC) after loop electrosurgical excision procedure (LEEP). Methods: Clinical data were collected from patients who were admitted to the First Affiliated Hospital of Nanjing Medical University from April 2014 to February 2026. Patients with AIS diagnosed by colposcopy-guided sampling or LEEP and underwent total extrafascial hysterectomy within 4 months after LEEP were included in the study. Patients with, invasive squamous cell carcinoma or adenocarcinoma were excluded. The clinicopathological characteristics of the patients and the related factors affecting the detection of AIS or CAC in hysterectomy specimens were analyzed. Results: A total of 117 AIS patients were included in this study, with an age of (45.9±8.2) years at diagnosis. The results of high-risk human papillomavirus (HPV) test were all positive in 114 cases. Among 106 cases of cervical cytology, 32 cases (27.4%, 32/117) had negative for intraepithelial lesion or malignancy (NILM), 55 cases (47.0%, 55/117) had squamous cell abnormality, and 19 cases (16.2%, 19/117) had glandular cell abnormality. Seventy-seven cases (65.8%, 77/117) of AIS were detected by colposcopic sampling, and 40 cases (34.2%, 40/117) were detected by LEEP. Ninety-eight patients (98/117, 83.8%) and 19 patients (19/117, 16.2%) received LEEP once and twice, respectively. The positive rate of surgical margins after the last LEEP was 16.2% (19/117), and the residual rate of lesions in 19 patients with positive margins was 8/19, including 5 cases (5/19) of AIS and 3 cases (3/19) of CAC. The rate of negative margins after the last LEEP was 83.8% (98/117). The residual rate of lesions in 98 patients with negative margins was 17.4% (17/98), all of which were AIS residual, and no CAC residual. Univariate analysis showed that the risk of residual AIS or CAC in patients with positive resection margin was significantly higher than that in patients with negative resection margin (OR=3.465, 95%CI: 1.212-9.904; P=0.016). Conclusions: The efficiency of cervical cytology and colposcopy in the identification of AIS is low. Positive surgical margin after LEEP is associated with a higher residual risk of AIS and CAC. Patients with negative surgical margins have a low risk of residual invasive lesions, and fertility preservation treatment can be considered.