Introduction/Background Internationally, there is little consensus about the best treatment for cervical adenocarcinoma in situ (AIS), i.e., large loop excision of the transformation zone (LLETZ), conisation, or (supplementary) hysterectomy after completion of childbearing. This study aims to compare the incidence of recurrent AIS and progression to adenocarcinoma following these treatments.
Methodology From the Dutch Nationwide Pathology Databank (Palga) AIS patients who underwent treatment between 2011 and 2021 in the Netherlands were identified. Their survival status was retrieved from the Central Bureau of Genealogy. Patients diagnosed with cervical cancer within 3 months after AIS treatment were excluded. The cumulative incidence of recurrent AIS and progression to adenocarcinoma following LLETZ, conisation, and hysterectomy were compared.
Results In total, 2,443 patients with AIS were identified, of whom 21,617 pathology reports were available. Primary treatment consisted of 1,069 LLETZ, 1,085 conisations, and 289 hysterectomies. Recurrent AIS was diagnosed in 73 patients and progression to adenocarcinoma occurred in 12 patients. The cumulative incidence of recurrent AIS after LLETZ was 6.0% (95% confidence interval (CI): 4.1–8.0), after conisation 2.6% (95% CI: 1.2–4.0), and after hysterectomy no recurrences occurred. The cumulative incidence of progression to adenocarcinoma was 0.6% (95%CI: 0.1–1.1), 0.8% (95%CI: 0.1–1.4), and 0.4% (95%CI: 0–1.3) following LLETZ, conisation, and hysterectomy, respectively. The cumulative incidence of recurrent AIS did not differ between LLETZ versus hysterectomy (p=0.992) and conisation versus hysterectomy (p=0.993), but the cumulative incidence of recurrent AIS was increased following LLETZ compared to conisation (HR2.27, 95%CI: 1.38–3.71; p=0.001). The rate of progression to adenocarcinoma did not differ between LLETZ, conisation and hysterectomy.
Conclusion Conisation is a safe treatment for AIS compared to hysterectomy. For LLETZ the recurrence and progression rates are slightly elevated but still low, indicating that LLETZ could be offered as superior fertility-sparing treatment in women motivated to adhere to stringent follow-up.
Disclosures Nothing to disclose.
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