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Risk of persistent or recurrent cervical neoplasia in patients with ‘pure’ adenocarcinoma‐in‐situ ( AIS ) or mixed AIS and high‐grade cervical squamous neoplasia (cervical intra‐epithelial neoplasia grades 2 and 3 ( CIN 2/3)): a population‐based study
Author(s) -
Codde E,
Munro A,
Stewart CJR,
Spilsbury K,
Bowen S,
Codde J,
Steel N,
Leung Y,
Tan J,
Salfinger SG,
Mohan GR,
Cohen PA
Publication year - 2018
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14808
Subject(s) - medicine , cervical intraepithelial neoplasia , cervical cancer , cancer
Objective To compare outcomes of patients with pure adenocarcinoma‐in‐situ ( AIS ) and mixed AIS / CIN 2/3 lesions including the incidence of AIS persistence, recurrence and progression to adenocarcinoma. Design Retrospective cohort study. Setting Statewide population in Western Australia. Population Women diagnosed with AIS between 2001 and 2012. Methods We conducted a retrospective, population‐based cohort study. Main outcome measures De‐identified linked data were utilised to ascertain the association between patient age at excisional treatment, margin status, lesion type, lesion size, and risk of persistent AIS (defined as the presence of AIS <12 months from treatment), recurrent AIS (≥12 months post‐treatment), and adenocarcinoma. Results 636 patients were eligible for analysis. The mean age was 32.3 years and median follow‐up interval was 2.5 years. Within the study cohort, 266 patients (41.8%) had pure AIS and 370 (58.2%) had mixed AIS / CIN 2/3. Overall, 47 patients (7.4%) had AIS persistence/recurrence and 12 (1.9%) had adenocarcinoma. Factors associated with persistence/recurrence were pure AIS (hazard ratio ( HR ) 2.3; 95% CI 1.28–3.94; P = 0.005), age >30 years ( HR 2.1; 95% CI 1.16–3.81; P = 0.015), positive endocervical margins ( HR 5.8; 95% CI 3.05–10.92; P = <0.001) and AIS lesions >8 mm ( HR 2.5; 95% CI 1.00–6.20; P = 0.049). A histologically positive AIS ectocervical margin was not associated with persistence/recurrence. Conclusion In this study, pure AIS was associated with greater risk of persistence/recurrence than was mixed AIS / CIN 2/3. AIS lesions >8 mm and positive endocervical margins were significant predictors for persistent or recurrent disease. Tweetable Abstract Pure cervical adenocarcinoma‐in‐situ ( AIS ) may have greater risk of recurrence than AIS co‐existing with CIN 2/3.