Exploring uterine involvement in hysterectomy samples following conization for adenocarcinoma in situ of the uterine cervix: Insights from a multicenter study by the FRANCOGYN group
Résumé
Background: Adenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy
is standard, conservative management may be considered for women desiring future pregnancies. This
study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional
therapy with clear margins for AIS.
Methods: A retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy
after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence
of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative
predictors of residual disease and comparing recurrence rates between patients with and without residual
disease.
Results: Of 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed
residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group,
18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI
(27.5 kg/m2 vs. 23.6 kg/m2, p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences
were observed during follow-up.
Conclusion: Despite clear margins on the initial conization for AIS, 20% of patients had residual disease in their
hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after
completing childbearing, even if initial margins are clear.