Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix

Shawna L. Bull-Phelps, Elizabeth I O Garner, Christine S. Walsh, Paola A. Gehrig, David S. Miller, John O. Schorge

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Objectives: Cervical adenocarcinoma in situ (AIS) is a precursor of invasive disease that is increasing in incidence primarily among reproductive-age women of low parity. Conization is an alternative to hysterectomy that allows future pregnancy, but has an inherent risk of residual AIS. The purpose of this study was to determine the outcomes of patients treated by this fertility-sparing strategy over an extended period of surveillance. Methods: Women diagnosed with cervical AIS who underwent primary fertility-sparing surgery with either loop excision or cold knife conization between 1993 and 2001 were identified at three institutions. A retrospective medical record review was performed. Patients 40 years of age and older and those undergoing hysterectomy within 12 months of diagnosis were excluded. Results: A total of 101 women underwent cone biopsy and expectant management. The median age was 29 years. Fifty-seven percent were nulliparous and 23% primiparous. Cold knife conization was most commonly performed (69 vs. 32 procedures) and had a higher efficacy of achieving negative margins (72% vs. 47%; P = 0.036). Thirty-five women had a total of 49 pregnancies during a mean follow-up of 51 months. Thirty-five gestations were delivered at term. There were two preterm births, eight spontaneous miscarriages, three elective terminations, and one ectopic pregnancy. Thirty-six patients had a repeat cone biopsy. Five ultimately underwent hysterectomy. No invasive cervical adenocarcinomas were observed during the study interval. Conclusion: Fertility-sparing surgery enables women with cervical AIS to achieve pregnancy with minimal risk of developing invasive disease during surveillance.

Original languageEnglish (US)
Pages (from-to)316-319
Number of pages4
JournalGynecologic Oncology
Volume107
Issue number2
DOIs
StatePublished - Nov 2007

Fingerprint

Cervix Uteri
Fertility
Conization
Hysterectomy
Pregnancy
Biopsy
Ectopic Pregnancy
Premature Birth
Spontaneous Abortion
Parity
Medical Records
Adenocarcinoma
Adenocarcinoma in Situ
Incidence

Keywords

  • Adenocarcinoma in situ
  • Cervical adenocarcinoma
  • Fertility-sparing surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Bull-Phelps, S. L., Garner, E. I. O., Walsh, C. S., Gehrig, P. A., Miller, D. S., & Schorge, J. O. (2007). Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. Gynecologic Oncology, 107(2), 316-319. https://doi.org/10.1016/j.ygyno.2007.06.021

Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. / Bull-Phelps, Shawna L.; Garner, Elizabeth I O; Walsh, Christine S.; Gehrig, Paola A.; Miller, David S.; Schorge, John O.

In: Gynecologic Oncology, Vol. 107, No. 2, 11.2007, p. 316-319.

Research output: Contribution to journalArticle

Bull-Phelps, SL, Garner, EIO, Walsh, CS, Gehrig, PA, Miller, DS & Schorge, JO 2007, 'Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix', Gynecologic Oncology, vol. 107, no. 2, pp. 316-319. https://doi.org/10.1016/j.ygyno.2007.06.021
Bull-Phelps, Shawna L. ; Garner, Elizabeth I O ; Walsh, Christine S. ; Gehrig, Paola A. ; Miller, David S. ; Schorge, John O. / Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix. In: Gynecologic Oncology. 2007 ; Vol. 107, No. 2. pp. 316-319.
@article{cefe5233d5df45d2bb0f0372b7f0eb1d,
title = "Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix",
abstract = "Objectives: Cervical adenocarcinoma in situ (AIS) is a precursor of invasive disease that is increasing in incidence primarily among reproductive-age women of low parity. Conization is an alternative to hysterectomy that allows future pregnancy, but has an inherent risk of residual AIS. The purpose of this study was to determine the outcomes of patients treated by this fertility-sparing strategy over an extended period of surveillance. Methods: Women diagnosed with cervical AIS who underwent primary fertility-sparing surgery with either loop excision or cold knife conization between 1993 and 2001 were identified at three institutions. A retrospective medical record review was performed. Patients 40 years of age and older and those undergoing hysterectomy within 12 months of diagnosis were excluded. Results: A total of 101 women underwent cone biopsy and expectant management. The median age was 29 years. Fifty-seven percent were nulliparous and 23{\%} primiparous. Cold knife conization was most commonly performed (69 vs. 32 procedures) and had a higher efficacy of achieving negative margins (72{\%} vs. 47{\%}; P = 0.036). Thirty-five women had a total of 49 pregnancies during a mean follow-up of 51 months. Thirty-five gestations were delivered at term. There were two preterm births, eight spontaneous miscarriages, three elective terminations, and one ectopic pregnancy. Thirty-six patients had a repeat cone biopsy. Five ultimately underwent hysterectomy. No invasive cervical adenocarcinomas were observed during the study interval. Conclusion: Fertility-sparing surgery enables women with cervical AIS to achieve pregnancy with minimal risk of developing invasive disease during surveillance.",
keywords = "Adenocarcinoma in situ, Cervical adenocarcinoma, Fertility-sparing surgery",
author = "Bull-Phelps, {Shawna L.} and Garner, {Elizabeth I O} and Walsh, {Christine S.} and Gehrig, {Paola A.} and Miller, {David S.} and Schorge, {John O.}",
year = "2007",
month = "11",
doi = "10.1016/j.ygyno.2007.06.021",
language = "English (US)",
volume = "107",
pages = "316--319",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "2",

}

TY - JOUR

T1 - Fertility-sparing surgery in 101 women with adenocarcinoma in situ of the cervix

AU - Bull-Phelps, Shawna L.

AU - Garner, Elizabeth I O

AU - Walsh, Christine S.

AU - Gehrig, Paola A.

AU - Miller, David S.

AU - Schorge, John O.

PY - 2007/11

Y1 - 2007/11

N2 - Objectives: Cervical adenocarcinoma in situ (AIS) is a precursor of invasive disease that is increasing in incidence primarily among reproductive-age women of low parity. Conization is an alternative to hysterectomy that allows future pregnancy, but has an inherent risk of residual AIS. The purpose of this study was to determine the outcomes of patients treated by this fertility-sparing strategy over an extended period of surveillance. Methods: Women diagnosed with cervical AIS who underwent primary fertility-sparing surgery with either loop excision or cold knife conization between 1993 and 2001 were identified at three institutions. A retrospective medical record review was performed. Patients 40 years of age and older and those undergoing hysterectomy within 12 months of diagnosis were excluded. Results: A total of 101 women underwent cone biopsy and expectant management. The median age was 29 years. Fifty-seven percent were nulliparous and 23% primiparous. Cold knife conization was most commonly performed (69 vs. 32 procedures) and had a higher efficacy of achieving negative margins (72% vs. 47%; P = 0.036). Thirty-five women had a total of 49 pregnancies during a mean follow-up of 51 months. Thirty-five gestations were delivered at term. There were two preterm births, eight spontaneous miscarriages, three elective terminations, and one ectopic pregnancy. Thirty-six patients had a repeat cone biopsy. Five ultimately underwent hysterectomy. No invasive cervical adenocarcinomas were observed during the study interval. Conclusion: Fertility-sparing surgery enables women with cervical AIS to achieve pregnancy with minimal risk of developing invasive disease during surveillance.

AB - Objectives: Cervical adenocarcinoma in situ (AIS) is a precursor of invasive disease that is increasing in incidence primarily among reproductive-age women of low parity. Conization is an alternative to hysterectomy that allows future pregnancy, but has an inherent risk of residual AIS. The purpose of this study was to determine the outcomes of patients treated by this fertility-sparing strategy over an extended period of surveillance. Methods: Women diagnosed with cervical AIS who underwent primary fertility-sparing surgery with either loop excision or cold knife conization between 1993 and 2001 were identified at three institutions. A retrospective medical record review was performed. Patients 40 years of age and older and those undergoing hysterectomy within 12 months of diagnosis were excluded. Results: A total of 101 women underwent cone biopsy and expectant management. The median age was 29 years. Fifty-seven percent were nulliparous and 23% primiparous. Cold knife conization was most commonly performed (69 vs. 32 procedures) and had a higher efficacy of achieving negative margins (72% vs. 47%; P = 0.036). Thirty-five women had a total of 49 pregnancies during a mean follow-up of 51 months. Thirty-five gestations were delivered at term. There were two preterm births, eight spontaneous miscarriages, three elective terminations, and one ectopic pregnancy. Thirty-six patients had a repeat cone biopsy. Five ultimately underwent hysterectomy. No invasive cervical adenocarcinomas were observed during the study interval. Conclusion: Fertility-sparing surgery enables women with cervical AIS to achieve pregnancy with minimal risk of developing invasive disease during surveillance.

KW - Adenocarcinoma in situ

KW - Cervical adenocarcinoma

KW - Fertility-sparing surgery

UR - http://www.scopus.com/inward/record.url?scp=35348840209&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35348840209&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2007.06.021

DO - 10.1016/j.ygyno.2007.06.021

M3 - Article

C2 - 17689593

AN - SCOPUS:35348840209

VL - 107

SP - 316

EP - 319

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 2

ER -