Adenocarcinoma in situ (AIS) of the cervix is increasingly common due to HPV 18 predominance. Which management approach is correct for a 29-year-old woman with AIS on LLETZ with negative margins who desires fertility?
- A Immediate repeat LLETZ to ensure wider margins regardless of first LLETZ result
- B Hysterectomy is mandatory after AIS diagnosis even with clear margins
- C Co-testing (cytology + HPV) at 12 and 24 months, then annual for 3 years before return to routine screening ✓
- D Cold-knife cone with 6 mm margins is required even if LLETZ margins are clear
Explanation
AIS with negative excision margins on LLETZ in a woman desiring fertility may be conservatively managed with close surveillance (ASCCP 2019 guidelines: co-testing at 12 and 24 months, then annually for 3 years). If all tests are negative, she can return to routine screening. However, the risk of residual/recurrent AIS is ~10-15% even with negative LLETZ margins due to the multifocal and skip lesion nature of AIS, necessitating long-term follow-up. Hysterectomy is recommended after childbearing is complete. Immediate repeat LLETZ is only required if margins are positive or the endocervical canal was not adequately sampled.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.