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ECC, Cones, and in situ adeno ca of the cervix From: Geffrey H. Klein, MD (gklein@bcm.tmc.edu) Mon Jun 30 21:33:59 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Geffrey H. Klein, MD: "Misoprostol oral vs Vaginal" Previous message: DoctorJoe@aol.com: "Re: Another case from Malcolm" Two articles from July's Green Journal caught my eye.. The first: ___________ Endocervical Curettage, Cone Margins, and Residual Adenocarcinoma In Situ of the Cervix THAD R. DENEHY, MD, CATERINA A. GREGORI, MD, AND JAMES L. BREEN, MD Objective: To evaluate endocemical curettage (ECC) and cone margin involvement in the management of adenocarcinoma in situ of the cervix. Methods: Forty-two women with adenocarcinoma in situ without any associated invasive component underwent 49 cervical conizations. The ECC, cone margin involvement, and residual endocemical glandular disease were evaluated in a retrospective descriptive study. Results: The patients ranged from 18 to 65 years old, with a median of 34 years and a mean of 37 years. Nineteen of 42 (45%) of the women presented with initial cervicovaginal cytology suggesting endocervical glandular abnormality. Twenty-seven patients (64%) had mixed lesions of adenocarcinema in situ and squamous dysplasia noted in their cervical biopsy, conization, or hysterectomy specimens. Forty ECCs were performed at colposcopy or immediately after conization; 28 patients with ECCs subsequently under-went conization, and 12 underwent hysterectomy. Residual adenocarcinoma in situ was found in 18 (67%) of the 27 patients with negative ECCs and in ten of 13 women with positive ECCS. Residual adenocarcinoma in situ was found in two of seven patients with negative cone margins and seven of ten patients with positive margins. Conclusion: We found that negative ECCs and uninvolved cone margins in patients with cervical adenocarcinoma in situ were not reassuring of the absence of residual endocervical glandular disease in subsequent surgical specimens. Conservative management and subsequent surveillance of adenocarcinoma in situ should be undertaken with caution. (Obstet Gynecol 1997,,90:1-6.) -- ________ Based on this research the authors write in the discussion: "... conservative management of adenocarcinoma in situ in women interested in reproductive preservation should be undertaken with trepidation, even if both cone margins and ECC are uninvolved, because there is no characteristic presently available that can be used to evaluate residual or recurrent endocervical disease reliably." and "Patients diagnosed with adenocarcinoma in situ upon conization who are not interested in childbearing should undergo a hysterectomy..." Any thoughts? Geffrey H. Klein, MD listowner: OB-GYN-L Advisory Board Chairman, OBGYN.net < http://www.obgyn.net > Co-moderator: sci.med.obgyn gklein@bcm.tmc.edu gklein@icsi.net http://members.aol.com/gklein01/geff.html 2200 Nasa Road 1, Suite 200 Houston, Texas 77058 Next message: Geffrey H. Klein, MD: "Misoprostol oral vs Vaginal" Previous message: DoctorJoe@aol.com: "Re: Another case from Malcolm"

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