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Challenges in Detection and Management of Pre-invasive Glandular Lesions of the Cervix

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Abstract

Despite the success of cervical screening, we continue to see an increase in pre-invasive glandular lesions, and subsequent adenocarcinomas of the cervix. Atypical glandular cells are reported in approximately 0.17–0.6% of cervical cytology samples; up to one-third have underlying pathology that requires further treatment. Glandular lesions of the cervix present unique diagnostic and therapeutic challenges. Colposcopy is often less reliable for assessment of glandular lesions. The role of HPV testing and ECC in diagnosis and surveillance is unclear. Conventional belief is that cold knife conization is superior to LEEP for management of adenocarcinoma in situ (AIS); however, more recent reviews suggest the procedures are oncologically equivalent so long as margins are interpretable and negative. As many young women with AIS desire fertility preservation, evidence on oncologic and obstetric outcomes following conservative management is emerging. The purpose of this review is to discuss some of the common challenges, from a clinician’s perspective, around detection and management of pre-invasive lesions of the cervix.

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Authors and Affiliations

  1. Division of Gynecologic Oncology, Dalhousie University, Halifax, NS, Canada

    Karla Willows & James R. Bentley

  2. Department of Obstetrics and Gynecology, IWK Health Centre Women’s Site, Room G2140, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada

    James R. Bentley

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KW was responsible for the literature review and for drafting > 80% of the manuscript. JRB was also involved in drafting parts of the review and revisions of the final manuscript. Both authors gave final approval for publication.

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Correspondence to James R. Bentley.

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Willows, K., Bentley, J.R. Challenges in Detection and Management of Pre-invasive Glandular Lesions of the Cervix. Indian J Gynecol Oncolog 17, 100 (2019). https://doi.org/10.1007/s40944-019-0348-4

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