Analysis Of Clinical Characteristics Of Cervical Adenocarcinoma In Situ

Objective The clinical data and diagnosis and treatment of cervical adenocarcinoma in situ(AIS)were analyzed retrospectively in order to guide the early diagnosis and treatment of AIS.Methods From September 2011 to September 2018,a total of 77 patients who were diagnosed with adenocarcinoma in situ with squamous cell lesion and invasive adenocarcinoma by histopathology at dalian maternal and child health hospital affiliated to dalian medical university and underwent hysterectomy or cervical coning were included.General diagnosis and treatment information,cytology,HPV infection status,colposcopy and biopsy reports,preliminary treatment,follow-up treatment,pathological results and follow-up results were retrospectively analyzed.Results From September 2011 to September 2018,there were 77 patients with cervical adenocarcinoma in situ,aged 27-62 years,with an average age of(41.01 ±7.79)years.The average number of pregnancies was 2.55±0.97/1.23±0.56.There were 11 postmenopausal patients(14.28%).The cervical surface was smooth in 45cases(58.44%).52 patients(67.53%)had no obvious symptoms.22 patients(28.57%)showed irregular vaginal bleeding(18 cases of contact bleeding and 4 cases of blood filament in leucorrhea).The positive rate of high-risk HPV detection in 66 patients with HPV infection data was 96.97%,including 25 cases of HPV16 type(37.88%)and 20 cases of HPV18 type(30.30%).The positive rate of high-risk HPV detection in 66 patients with HPV infection data was 96.97%,including 25 cases of HPV16 type(37.88%)and 20 cases of HPV18 type(30.30%).Cervical cytological examination results of 77 patients showed 15 cases of ASCUS,5 cases of LSIL,7 cases of ASC-H,23 cases of HSIL,9 cases of AGC,1 case of AIS and 17 cases of NILM.Cytologically, there were 10 cases(12.99%)of glandular epithelial abnormalities,among which only 1case(1.30%)was AIS,among which 6 cases were pure AIS and(or with)invasive adenocarcinoma were 2 cases,and 2 cases were mixed AIS patients with cervical squamous cell lesions.All 77 patients underwent colposcopy,and the pathological results of multipoint biopsy ±ECC under colposcopy showed that 45 patients(58.44%)showed abnormal glandular cell,among which 18 patients(23.38%)showed pure AIS,25 patients(32.47%)showed AIS complicated with varying degrees of CIN,and 1patient(1.30%)showed AIS complicated with suspected early invasive cervical squamous cell carcinoma.31 cases(40.26%)suggested cervical HSIL.1 case(1.30%)indicated inflammation.One of the 77 patients was required to undergo total hysterectomy directly because of age.The pathology showed that the other 76 cases of AIS with CINIII,received cold knife cervical conization as the initial treatment,20cases(26.32%)of simple AIS and 12 cases(15.79%)of invasive adenocarcinoma or squamous cell carcinoma,of which only one case of AIS with squamous cell carcinoma showed squamous cell carcinoma at the time of biopsy,and 44 cases of AIS with HSIL(57.89%).28 patients with AIS received follow-up hysterectomy mainly because of positive cutting edge or uncertain evaluation of the previous operation.8 cases(28.57%)had residual lesions,of which 7 cases had lesions ≤ 10 mm from the incisal margin in the previous operation,including 5 cases of residual AIS,2 cases of residual AIS with HSIL and 1 case of Ia1 stage of invasive adenocarcinoma(3.57%).37 patients without hysterectomy were followed up,and 3 patients lost follow-up.The follow-up method was to ask the patients to receive combined screening results of TCT and HPV at 6months,12 months and follow-up time after operation and whether there was any follow-up treatment.The median follow-up time was 40.37 ± 18.91 months.So far,there was no recurrence of AIS,.None of the patients developed invasive cancer.The lesions of 4 patients were less than 10 mm from the incisal margin,and were closely followed up because of fertility requirements,Among the 64 AIS patients,9 cases had lesions ≤ 10 mm from the cutting edge,and 6 cases could not be evaluated at the cutting edge,28 patients with AIS in the hysterectomy group were followed up and there was no recurrence of AIS.Conclusions In clinical work,AIS is relatively rare compared with CIN,and the age of onset is about 40 years old.AIS usually has no obvious symptoms and often coexists with CIN.The positive rate of HPV high-risk type is higher.The combined screening of HPV and cytology is helpful for the early detection of AIS.Cervical multi-point biopsy under colposcope and ECC to improve AIS diagnostic rate,histopathologic diagnosis method of AIS,AIS patients have suggested line diagnostic cone cut method in diagnosis and making further treatment plan,should be in accordance with the requirements of the patient’s own age,presence of fertility,presence of multiple lesions,the cut edge situation such as choosing the appropriate individualized treatment plan.Patients with AIS should carefully evaluate the cutting edge of the first cervical conization if they choose surgery to preserve reproductive function,and must be followed up closely for a long time.Patients with positive margins have a relatively high risk of developing invasive adenocarcinoma,for patients with positive incisal margin for the first time,secondary conization is recommended in addition to adenocarcinoma and close follow-up or direct total hysterectomy.