Introduction/Background Treatment and follow-up of glandular precancerous lesions of the uterine cervix are different from squamous lesions mostly due to the risk of skip lesions (discontinuous spread of dysplasia in endocervical mucosa).

The aim of our study was to investigate the occurrence of skip lesions and assess the risk factors associated with recurrence in the patients after fertility sparing treatment for adenocarcinoma in situ (AIS) and pT1a adenocarcinoma (AC).

Methodology We retrospectively reviewed all patients with histopathologically verified AIS or FIGO 2018 IA cervical AC treated in a single center between years 2002 and 2023. Analyzed were specimens from consecutive surgeries in order to acquire the occurrence of skip lesions. Factors associated with recurrence were assessed in 86 patients after fertility sparing treatment with availability of long-term follow-up data (mean follow-up length was 57 ± 45 months).

Results Generally, 143 patients (112 with AIS and 31 with AC) were included in the analysis. Skip lesion was identified in 11 of 33 (33%) patients who underwent secondary cervical surgery (repeated cone biopsy or hysteretomy) in an interval shorter than 6 months. Recurrence rate after fertility sparing treatment was 9% (12% for AIS and 4% for AC).

In the follow-up, no HPV negative patient experienced recurrence. In HPV positive patients, recurrence rate was 38%. HPV 16/18 positivity was strongly associated with the risk of recurrence than other high-risk genotypes (83% vs. 10%; p=0.015, log-rank).

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Abstract #320 Figure 1

Kaplan-Meier estimate of disease free survival in patients after fertility sparing treatment of adenocarcioma in situ and microinvasive carcinoma of the uterine cervix according to the HPV status in the follow-up

Conclusion In our retrospective study of 143 patients, we confirmed high risk of skip lesions after fertility sparing treatment of patients with AIS or microinvasive AC. Risk of recurrence was strongly associated with HPV status. We found no case of recurrence in HPV negative patients. HPV testing and genotyping can be used as a triage mechanism in follow-up these patients.

(Supported by MH CZ - DRO - VFN00064165)