Clinical Characteristics Of 92 Cases With Adenocarcinoma In Situ Of Cervix

Objective:The aim of this study was to investigate the role of screening,diagnosis and management of AIS by analyzing the the clinical manifestations,high risk human papillomavirus(HR-HPV)status,liquid-based cytology(LCT),postoperative pathology of colposcopic cervical biopsy,pathology post cold knife conization(CKC)or loop electrosurgical excision procedure(LEEP)and/or total hysterectomy of 92 cases with adenocarcinoma in situ of cervix.Methods:We retrospectively reviewed data from 92 patients with AIS admitted to the Affiliated Hospital of Qingdao University between January 2013 to July 2020.The age,gravidity and parity history,clinical symptoms,gynecological conditions,HR-HPV status,liquid based cytology,pathology post CKC,LEEP or hysterectomy were analyzed.Results:1)The age of onset of AIS was between 28 to 70 years,the mean age was39±8.65 years,and 53 patients(57.6%)were ≤ 40 years.The mean number of pregnancies was 3 ± 1.29(0 – 6),and the mean number of gravidity was 1± 0.69(0-4).2)67.4% of the patients had no obvious clinical symptoms,20.7% had contact bleeding,6.5% presented with abnormal vaginal discharge,and 5.4% had abnormal uterine or vaginal bleeding.Cervical appearance:Smooth cervix presented in 22.8% of the patients,mild cervical columnar epithelial shift presented in 38% patients,moderate cervical columnar epithelial shift presented in 26.1% patients,and severe cervical columnar epithelial shift presented in 13.1% patients.3)88 patients underwent HPV-related testing,15 patients(17.1%)underwent HC2 testing,and 14 patients(93.3%)were positive;there were 62 patients(70.4%)who underwent HPV typing test,of which 23(37.1%)were HPV16 positive,19(30.8%)were HPV18 positive,and 3(4.8%)were HPV45 positive;there were 11 patients(12.5%)who underwent both HC2 and HPV typing tests,and 10 patients were both positive for both tests,with a positive rate of 91%.4)82 patients underwent cervical liquid-based cytology(LCT),and pathology revealed 12 patients(14.6%)with atypical squamous cells of undetermined significance(ASC-US),11 patients(13.4%)with atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion(ASC-H),27 patients(32.9%)with high-grade squamous intraepithelial lesion(HISL),2 patients(2.4%)with low-grade squamous intraepithelial lesion(LSIL),9 patients(11%)with atypical glandular cells(AGC),and 21 patients(25.6%)without intraepithelial neoplasia or malignant lesions.5)92 patients underwent colposcopic cervical biopsy,and the pathological results showed 45 patients(49.9%)with AIS alone,28 patients(30.4%)with AIS with CIN(1-3)grade,13 patients(14.1%)with HSIL alone,1 patient(1.1%)with LSIL alone,1 patient(1.1%)with inflammation,and 4 patients(4.4%)with AIS that could not be exclu ded.A total of 45 patients underwent ECC during colposcopy and 38 patients had positive pathological results,with a diagnostic positive rate of 84.4%.6)87 patients underwent CKC/LEEP,including only 4 patients who underwent LEEP and 83 patients who underwent CKC.The postoperative pathology of CKC and LEEP was: 6 patient(6.9%)with HSIL,31 patients(35.6%)with AIS,10 patients(11.5%)with adenocarcinoma,27 patients(31%)with AIS and HSIL,3 patients(3.5%)with AIS and LISL,and 4 patients(4.6%)with LSIL,6 patients(6.9%)with chronic inflammation.7)10 of the 87 patients underwent CKC/LEEP with postoperative pathology of adenocarcinoma,and only cases with pathological diagnosis of AIS after CKC/LEEP were statistically analyzed in this paper.45 patients underwent further total hysterectomy.The interval between further total hysterectomy and CKC/LEEP was 4-120 days,and the number of days was 37.5 ± 4.83 days.45 patients underwent total laparoscopic hysterectomy.The pathological results after total hysterectomy showed that 32 patients(71.2%)had no residual tumor,9 patients(20%)had AIS alone,1 patients(2.2%)had HSIL,1 patients(2.2%)had LSIL and 2 patient(4.4%)had adenocarcinoma.8)68 patients were followed up for 6-90 months after surgery,3lost follow-up.12 patients were not regularly reexamined after surgery.Follow-up was 96.7%.Conclusion:1.HPV45 infection may be another major oncogenic viral type of cervical AIS in addition to HPV16 and 18 infection.2.Cervical CKC/LEEP is the established method to determine cervical AIS,but a part of cervical AIS can still be missed.