This protocol addresses the specific clinical scenario of cervical adenocarcinoma in situ (AIS) in a patient of reproductive age who desires future pregnancy, has achieved negative margin status on cervical conization, and is willing and able to adhere to a surveillance programme.
The patient is of reproductive age, has a confirmed diagnosis of cervical AIS, and has undergone conization with negative margins achieved. She has expressed a clear desire for future pregnancy and is committed to the follow-up required for fertility-sparing management. For this population, fertility-sparing management with a conization procedure is an acceptable approach when negative margins have been confirmed and surveillance adherence can be ensured.
DOI: 10.1097/AOG.0000000000003761
For patients of reproductive age who desire future pregnancy, for whom negative margin status on conization has been achieved, and who are willing and able to adhere to surveillance recommendations, fertility-sparing management with a conization procedure is acceptable (AII).
For patients in whom negative margins cannot be achieved after multiple excisional procedures, hysterectomy is recommended, and fertility-sparing management should be pursued only in select cases and after a frank discussion about the significantly increased risk of persistent or recurrent AIS and cancer.
Data are lacking on outcomes after radical trachelectomy for treatment of persistent AIS, but it could be considered as an alternative for patients who strongly desire future fertility.
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