Cervical adenocarcinoma in situ
ICD-10 D06 · ICD-11 2E66

Treatment of Cervical Adenocarcinoma In Situ: Surgical Excision and Pathological Evaluation

Cervical adenocarcinoma in situ (AIS) is a precancerous glandular lesion of the cervix that requires careful surgical and pathological evaluation before definitive management is determined. The central clinical priority is excluding occult invasive adenocarcinoma.

Approach

Management is built around a surgical excisional procedure, which serves both a diagnostic and therapeutic role. The integrity of the excised specimen and precise assessment of margin status are critical to guiding subsequent decisions, including in patients for whom definitive surgery is already planned.

Treatment Overview

The recommended approach involves a specific excisional technique — selected according to the surgeon's ability to consistently obtain an intact specimen of adequate dimensions — with additional endocervical evaluation following excision. Full technique selection criteria, specimen requirements, and subsequent evaluation steps are available in the complete protocol.

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References

  1. A diagnostic excisional procedure is recommended to rule-out an invasive adenocarcinoma, even when definitive hysterectomy is planned (AII).
  2. Excisional procedures optimally result in removal of an intact specimen to facilitate accurate interpretation of margin status. Thus, excision by cold knife conization is preferred unless the surgeon is able to consistently remove an intact ("top hat" endocervical excision is unacceptable) specimen of adequate length and width (AII).
  3. Length of the excisional specimen of at least 10 mm is preferred and can be increased to 18–20 mm in patients who have completed childbearing (BII). Endocervical sampling above the excisional bed to evaluate for residual disease is preferred (CIII).

DOI: 10.1097/AOG.0000000000003761

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