Adenocarcinoma in situ of the uterine cervix: a metaanalysis of 1278 patients evaluating the predictive value of conization margin status

Am J Obstet Gynecol. 2009 Feb;200(2):182.e1-5. doi: 10.1016/j.ajog.2008.09.012. Epub 2008 Nov 18.


Objective: We sought to determine the value of conization margin status in predicting residual and recurrent adenocarcinoma in situ (ACIS) of the cervix.

Study design: In all, 33 studies (1278 patients) were identified. Metaanalysis with pooled Mantel-Haenszel odds ratio (OR) was used to compare the risk of residual and recurrent disease according to margin status.

Results: A repeated excisional procedure was performed in 607 patients; a positive conization margin was associated with a significant increase in the risk of residual disease (OR, 4.01; 95% confidence interval [CI], 2.62-6.33; P < .001). Of the 671 patients followed up with surveillance only, 2.6% with negative margins and 19.4% with positive margins developed a recurrence (OR, 2.48; 95% CI, 1.05-6.22; P < .001). Invasive adenocarcinoma was more commonly associated with positive margins (5.2%) compared with negative margins (0.1%).

Conclusion: After conization for ACIS, patients with positive margins are significantly more likely to have residual or recurrent disease, whereas those with negative margins may be treated conservatively.

Publication types

  • Meta-Analysis

MeSH terms

  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Adult
  • Carcinoma in Situ / pathology*
  • Carcinoma in Situ / surgery
  • Cervix Uteri / pathology
  • Conization*
  • Female
  • Humans
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm, Residual / epidemiology*
  • Predictive Value of Tests
  • Reoperation
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery