Objective To evaluate conservative treatment in patients with a diagnosis of adenocarcinoma in situ (AIS) patients in Southern Brazil.

Methods/Materials A retrospective cohort study of patients diagnosed with AIS between 2002 and 2019. Clinical characteristics and pathologic information including specimen volume, margin status, treatment type, pregnancy and oncologic outcomes were collected.

Results The mean age was 39.7 years (SD ± 9.4). The initial treatment performed was loop electrosurgical excision procedure (LEEP) in seven (21,2%) participants, cold-knife-cone (CKC) in 26 (78.8%). After the conization, 18 women underwent conservative management, three patients (3/18) became pregnant once and another two patients (2/18) went to hysterectomy in the follow-up. Residual lesion was noted in 7 (41%) hysterectomy specimens, with 2 cases of adenocarcinoma. In our study, an inverse association was found between the volume of the surgical specimen (in mm3) in the LEEP procedure (p = 0.033) and the positive surgical margin (p = 0.012). There was no association between the treatment performed, the volume of the surgical specimen, and recurrence with negative or positive margins (p> 0.05).

Conclusion Conservative treatment is an option in the treatment of AIS, for patients who desire fertility-sparing treatment. Conservative management with LEEP is associated with higher positive margin rates than CKC, however outcomes were similar when margins are negative. The specimen volume was not associated with recurrence.