Department of Pathology, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Low Genit Tract Dis. 2021 Jan 1;25(1):38-42. doi: 10.1097/LGT.0000000000000579.
The risks of adenocarcinoma in situ (AIS) recurrence or progression after conservative treatment are uncertain. The aim of this study was to examine the role of high-risk human papillomavirus (hrHPV) and cytology in the posttreatment surveillance of AIS patients.
Follow-up results of hrHPV status, cytology results, and clinicopathological features of 207 patients were retrospectively analyzed, in whom AIS was initially treated by loop electrosurgical excision procedure (LEEP)/cone biopsy between September 2009 and June 2018.
Among 207 patients diagnosed AIS on LEEP/cone biopsy, 30.9% (64/207) had positive margins. Persistent/recurrent AIS rate was substantially higher in the patients with positive margins than in those with negative margins (47.2% vs 9.3%, p < .001). Of 74 patients with hrHPV surveillance, 17 (17/74, 23.0%) were found to have positive hrHPV and 4 (4/17, 23.5%) had the persistent/recurrent AIS regardless of margin status. On the contrast, no AIS were found in negative surveillant hrHPV patients (23.5% vs 0%, p < .001). Lastly, 27.8% patients (22/79) were reported atypical glandular cells on surveillant cytology, and 9 persistent/recurrent AIS cases were further identified on second biopsy or hysterectomy with a positive detection rate of 40.9%.
In this study, we concluded the positive margin on LEEP/cone biopsy in AIS patients was associated with a significantly greater risk of disease persistence or recurrence. The posttreatment surveillance by cytology and adjunct hrHPV would be an ideal strategy in predicting AIS persistence and recurrence, which will warrant further treatments.
关于保守治疗后，原位腺癌（AIS）复发或进展的风险尚不确定。本研究旨在探讨高危型人乳头瘤病毒（hrHPV）和细胞学在 AIS 患者治疗后监测中的作用。
回顾性分析 207 例 AIS 患者的 hrHPV 状态、细胞学结果和临床病理特征的随访结果，这些患者于 2009 年 9 月至 2018 年 6 月期间首次接受环电切除术（LEEP）/锥切术治疗。
在 207 例因 LEEP/cone 活检诊断为 AIS 的患者中，有 30.9%（64/207）有阳性边缘。与阴性边缘相比，阳性边缘的患者持续性/复发性 AIS 发生率显著更高（47.2%比 9.3%，p<0.001）。在 74 例接受 hrHPV 监测的患者中，有 17 例（17/74，23.0%）发现 hrHPV 阳性，4 例（4/17，23.5%）无论边缘状态如何，均出现持续性/复发性 AIS。相比之下，阴性监测 hrHPV 患者中未发现 AIS（23.5%比 0%，p<0.001）。最后，79 例患者中有 27.8%（22/79）的细胞学监测报告为非典型腺细胞，进一步在第二次活检或子宫切除术中发现 9 例持续性/复发性 AIS，阳性检出率为 40.9%。
在本研究中，我们发现 AIS 患者 LEEP/cone 活检阳性边缘与疾病持续性或复发的风险显著增加相关。细胞学和辅助 hrHPV 的治疗后监测是预测 AIS 持续性和复发的理想策略，这将需要进一步的治疗。
