Denehy T R, Gregori C A, Breen J L
Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
Obstet Gynecol. 1997 Jul;90(1):1-6. doi: 10.1016/S0029-7844(97)00122-1.
To evaluate endocervical curettage (ECC) and cone margin involvement in the management of adenocarcinoma in situ of the cervix.
Forty-two women with adenocarcinoma in situ without any associated invasive component underwent 49 cervical conizations. The ECC, cone margin involvement, and residual endocervical glandular disease were evaluated in a retrospective descriptive study.
The patients ranged from 18 to 65 years old, with a median of 34 years and a mean of 37 years. Nineteen of 42 (45%) of the women presented with initial cervicovaginal cytology suggesting endocervical glandular abnormality. Twenty-seven patients (64%) had mixed lesions of adenocarcinoma in situ and squamous dysplasia noted in their cervical biopsy, conization, or hysterectomy specimens. Forty ECCs were performed at colposcopy or immediately after conization; 28 patients with ECCs subsequently underwent conization, and 12 underwent hysterectomy. Residual adenocarcinoma in situ was found in 18 (67%) of the 27 patients with negative ECCs and in ten of 13 women with positive ECCs. Residual adenocarcinoma in situ was found in two of seven patients with negative cone margins and seven of ten patients with positive margins.
We found that negative ECCs and uninvolved cone margins in patients with cervical adenocarcinoma in situ were not reassuring of the absence of residual endocervical glandular disease in subsequent surgical specimens. Conservative management and subsequent surveillance of adenocarcinoma in situ should be undertaken with caution.
评估宫颈管搔刮术（ECC）及宫颈锥切切缘情况在宫颈原位腺癌治疗中的作用。
42例无任何相关浸润成分的宫颈原位腺癌患者接受了49次宫颈锥切术。在一项回顾性描述性研究中评估了ECC、锥切切缘情况及残留宫颈管腺性疾病。
患者年龄在18至65岁之间，中位年龄34岁，平均年龄37岁。42例患者中有19例（45%）最初的宫颈阴道细胞学检查提示宫颈管腺性异常。27例患者（64%）在宫颈活检、锥切或子宫切除标本中发现原位腺癌与鳞状上皮发育异常的混合病变。40次ECC在阴道镜检查时或锥切术后立即进行；28例行ECC的患者随后接受了锥切术，12例接受了子宫切除术。27例ECC结果为阴性的患者中有18例（67%）发现残留原位腺癌，13例ECC结果为阳性的患者中有10例发现残留原位腺癌。7例切缘阴性的患者中有2例发现残留原位腺癌，10例切缘阳性的患者中有7例发现残留原位腺癌。
我们发现，宫颈原位腺癌患者ECC结果为阴性及锥切切缘未受累并不能确保后续手术标本中不存在残留宫颈管腺性疾病。对原位腺癌进行保守治疗及后续监测时应谨慎。
