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RANZCOG Fellows' adherence to guidelines following cytological prediction of cervical adenocarcinoma-in-situ: Cause for concern?


Powell, A and Cohen, PA and Spilsbury, K and Blomfield, P, RANZCOG Fellows' adherence to guidelines following cytological prediction of cervical adenocarcinoma-in-situ: Cause for concern?, Australian and New Zealand Journal of Obstetrics and Gynecology, 59, (2) pp. 294-300. ISSN 0004-8666 (2018) [Refereed Article]

Copyright Statement

© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

DOI: doi:10.1111/ajo.12886


Background: For Australian women with screen-detected adenocarcinoma-in-situ (AIS), an excisional biopsy is mandatory for further assessment, treatment, and to exclude the presence of cervical adenocarcinoma. The only exclusion to this rule is if the woman has a clinically evident invasive cervical malignancy. Excisional treatments should be tailored according to a patient’s age and future obstetric needs. To date, practitioner compliance with this recommendation has not been investigated.

Aims: To investigate clinical management for patients with a cytological test re-sult predicting AIS. Secondary aims were to report the most severe histological findings of excisional biopsy specimens following cytological prediction of AIS and investigate treatment outcomes for conservatively managed patients with biopsy-confirmed AIS.

Materials and Methods: A retrospective, population-based cohort study was conducted. Cases were ascertained from the Tasmanian and Western Australia Cervical Screening Registries. Cytology and histology results for women with an index cervical smear reporting AIS from 2001 to 2012 were reviewed.

Results: Three hundred and twenty-one women (age range 18–69years) had an index smear reporting AIS. Cervical cancer was diagnosed in 62 (19.3%) patients within the study cohort. Twenty-one of 321 patients (6.7%) were not initially man-aged according to the 2005 NHMRC Guidelines for the management of asympto-matic women with screen-detected abnormalities, including two women diagnosed with an occult cancer following a total hysterectomy.

Conclusions: A minority of women were not managed in accordance with guide-lines. This is of concern given that nearly one in five women with a smear predicting AIS had a final diagnosis of cervical cancer.

Item Details

Item Type:Refereed Article
Keywords:adenocarcinoma-in-situ, cervical cytology, guidelines, management
Research Division:Biomedical and Clinical Sciences
Research Group:Oncology and carcinogenesis
Research Field:Cancer diagnosis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Blomfield, P (Associate Professor Penelope Blomfield)
ID Code:131685
Year Published:2018
Web of Science® Times Cited:2
Deposited By:Medicine
Deposited On:2019-03-29
Last Modified:2019-04-15

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