Department of Obstetrics, Gynecology & Women's Health, University of Minnesota, Minneapolis, Minnesota; the Department of Gynecology, Pacific Gynecology Specialists, Seattle, Washington; and the Departments of Obstetrics & Gynecology, The Ohio State University, Columbus, Ohio, University of Alabama at Birmingham, Birmingham, Alabama, and NYU Winthrop Hospital, Mineola, New York.
Obstet Gynecol. 2020 Apr;135(4):869-878. doi: 10.1097/AOG.0000000000003761.
This publication represents an extensive literature review with the goal of providing guidelines for the evaluation and management of cervical adenocarcinoma in situ (AIS). The authors drafted the guidelines on behalf of the Society of Gynecologic Oncology, and the guidelines have been reviewed and endorsed by the ASCCP. These guidelines harmonize with the ASCCP Risk-Based Management Consensus Guidelines and provide more specific guidance beyond that provided by the ASCCP guidelines. Examples of updates include recommendations to optimize the diagnostic excisional specimen, AIS management in the setting of positive compared with negative margins on the excisional specimen, surveillance and definitive management after fertility-sparing treatment, and management of AIS in pregnancy. The increasing incidence of AIS, its association with human papillomavirus-18 infection, challenges in diagnosis owing to frequent origin within the endocervical canal, and the possibility of skip lesions all make AIS a unique diagnosis whose management needs to be differentiated from the management of the more prevalent squamous cell dysplasia.
本出版物代表了广泛的文献综述，旨在为宫颈原位腺癌（AIS）的评估和管理提供指导。作者代表妇科肿瘤学会起草了这些指南，这些指南已经由 ASCCP 进行了审查和认可。这些指南与 ASCCP 基于风险的管理共识指南相协调，并提供了比 ASCCP 指南更具体的指导。更新的示例包括建议优化诊断性切除标本，在切除标本的边缘阳性与阴性时的 AIS 管理，生育保留治疗后的监测和明确管理，以及妊娠时 AIS 的管理。AIS 的发病率不断上升，与 HPV-18 感染相关，由于其起源于宫颈内口，因此在诊断方面存在挑战，并且可能存在跳跃性病变，所有这些都使得 AIS 成为一种独特的诊断，其管理需要与更常见的鳞状细胞发育不良的管理区分开来。
