Treatment of Cervical Adenocarcinoma In Situ When Conization Shows Positive Margins
In patients with a confirmed diagnosis of cervical adenocarcinoma in situ (AIS), a finding of positive margins on the cervical conization specimen raises the concern that an invasive cancer may not have been excluded — a situation requiring a specific management approach before proceeding to definitive surgery.
This protocol addresses the management of confirmed AIS where the cervical conization specimen returns with positive (involved) margins — meaning complete excision of the lesion has not been demonstrated on the first procedure.
When negative margins are not achieved on the first excision specimen, the protocol involves a further excisional step prior to hysterectomy, with the specific aim of excluding the presence of an invasive cancer. The complete recommended sequence, conditions under which this step applies, and the surgical options for definitive management are detailed in the full protocol.
Either modified radical hysterectomy or simple hysterectomy is acceptable for patients with confirmed diagnosis of AIS with positive margins on the conization specimen (CIII).
If negative margins are not achieved on the first excision specimen, a second excisional procedure is recommended before hysterectomy to exclude an invasive cancer unless this cannot be performed safely.
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