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

Treatment of Cervical Adenocarcinoma In Situ with Positive Margins on the Conization Specimen

Clinical Scenario

This protocol applies to patients with a confirmed diagnosis of cervical adenocarcinoma in situ (AIS) in whom the cervical conization specimen shows positive (involved) margins — indicating that excision has not achieved clear peripheral clearance of the lesion.

Treatment Approach

Management in this setting is surgical. The appropriate procedure is determined in part by whether the patient wishes to preserve future fertility. Surgical assessment of regional lymph nodes may also be incorporated at the time of the primary procedure.

The complete evidence-based protocol — including specific procedure selection, criteria for each surgical option, and lymph node assessment guidance — is available in full below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1097/AOG.0000000000003761

Either modified radical hysterectomy or simple hysterectomy is acceptable for patients with confirmed diagnosis of AIS with positive margins on the conization specimen (CIII).

For patients with a persistent positive margin despite repeat excisional procedures, a modified radical hysterectomy or radical trachelectomy for those who desire future pregnancy is acceptable owing to an increased risk of diagnosing an occult invasive carcinoma.

Surgical assessment of lymph nodes is acceptable at the time of hysterectomy (CIII).

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