Is laser conization adequate for therapeutic excision of adenocarcinoma in situ of the uterine cervix?

Aims: To determine the safety of uterine-preserving operations for adenocarcinoma in situ of the cervix. Methods: Fifteen cases of adenocarcinoma in situ (AIS) were diagnosed using neodymium:yttrium aluminum garnet (Nd:YAG) laser conization. The accuracy of preconization histology or cytology was evaluated in 15 AIS cases. In these AIS cases, we investigated how far the tumor was located from the squamocolumnar junction (SCJ) and the endocervix. Fourteen cases of the 15 AIS-affected patients were treated using laser conization alone. These patients were closely followed up. Results: Precise agreement between preconization diagnosis and conization histology was seen in 46.7% (7/ 15) of the AIS cases. In 14 of the 15 cases of AIS (93.3%), the tumor was adjacent to the transitional zone, within 3 mm of the SCJ, and in the other case (6.7%), the tumor was between 0 and 5 mm away from the SCJ. In all subjects, cone height was 8-18 mm (mean 13.1 mm). None of the 15 patients showed any recurrence of AIS during follow up ranging from 15 to 75 months (43.1 months on average). Conclusions: Women with AIS who want to preserve their fecundity might be treated with laser conization alone.