Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via F. Corridoni 11, 60123, Ancona, Italy.
Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via F. Corridoni 11, 60123, Ancona, Italy.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:273-277. doi: 10.1016/j.ejogrb.2019.07.014. Epub 2019 Jul 20.
to provide a practical tool for the evidenced-based management of adenocarcinoma in situ (AIS) of the uterine cervix, a challenging diagnosis encountered by colposcopists in their daily practice.
the proposed recommendations were drafted by the Italian Society of Colposcopy and Cervical Pathology (SICPCV) based on comprehensive reviews of previous guidelines, large uncontrolled studies, metanalysis, and sytematic reviews. The quality Level and the strength of the recommendations were graded and respectively expressed in Roman numbers (I-VI) and letters (A-E).
Women with all subcategories of abnormal glandular cells and AIS on cervical citology should be offered colposcopy with endocervical sampling (Strength of recommendation: A). In women with cytological AIS and negative colposcopy or endocervical curettage, an excisional treatment under colposcopic guidance is recommended (Strength of recommendation: A). If immediate post-conization endocervical sampling is positive, further conization is indicated (Strength of recommendation: C). In women who desire to preserve fertility with positive cone margins, further conization should be performed (Strength of recommendation: B). If colposcopy is adequate, a cylindrical excision that includes the whole transformation zone and at least 1-1.5 cm of endocervix beyond the squamous-columnar junction should be performed (Strength of recommendation: B). If colposcopy is inadequate, it is recommended that conization includes the whole transformation zone with a depth of 20-25 mm (Strength of recommendation: B). Hysterectomy is the standard definitive treatment for AIS in women who do not wish to preserve fertility (Strength of recommendation: B).
the proposed recommendations should enable clinicians to correctly diagnose, treat and follow AIS patients, avoiding mismanagement.
为宫颈原位腺癌（AIS）的循证管理提供实用工具，这是阴道镜医师在日常实践中遇到的具有挑战性的诊断。
意大利阴道镜和宫颈病理学会（SICPCV）根据对以往指南、大型非对照研究、荟萃分析和系统评价的综合回顾，起草了拟议建议。建议的质量水平和强度用罗马数字（I-VI）和字母（A-E）表示。
细胞学检查显示所有异常腺体细胞亚类和宫颈细胞学 AIS 的女性应行阴道镜检查和宫颈管取样（推荐强度：A）。细胞学 AIS 且阴道镜或宫颈管搔刮阴性的女性，推荐在阴道镜指导下行切除术（推荐强度：A）。如果即刻宫颈管搔刮阳性，应进一步锥切（推荐强度：C）。对于有生育要求、锥切边缘阳性的女性，应进一步锥切（推荐强度：B）。如果阴道镜检查充分，应行包括整个转化区在内的圆柱形切除术，且至少切除 1-1.5cm 宫颈管至鳞柱交界（推荐强度：B）。如果阴道镜检查不充分，应行包括整个转化区在内的锥切术，深度为 20-25mm（推荐强度：B）。对于无生育要求的 AIS 患者，子宫切除术是标准的明确治疗方法（推荐强度：B）。
这些建议应该能够使临床医生正确诊断、治疗和随访 AIS 患者，避免管理不当。
