Adenocarcinoma in situ follow-up - query bank

Question: Should a 34 year old who had Adenocarcinoma-in-situ excised 4 years ago with very small but clear margins and who has subsequently had normal follow-up smears and has completed her family have a hysterectomy or continue conservative follow-up?

Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.

Answer: Two guidelines on follow-up after adenocarcinoma in situ or cervical cancer were identified:


The ASCCP 2006 consensus guidelines(1) say that [in women with AIS] “Longterm follow-up is recommended for women who do not undergo hysterectomy.”


The 2008 sign guideline on cervical cancer (2) notes that evidence for the effectiveness of post-treatment surveillance is inconsistent. The guideline makes the following recommendations:

“Cervical cytology or vault smears are not indicated to detect asymptomatic recurrence of cervical cancer.”

“Patients with early stage disease who have had fertility conserving surgery should have a smear at six months, 12 months and annually for four years before being returned to the cervical screening programme”.

(Evidence level IV)


  1. Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D, 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ. Am J Obstet Gynecol 2007 Oct;197(4):340-5
  2. Scottish Intercollegiate Guidelines Network. Management of cervical cancer. 2008. 


Search date: April 2010

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

This clinical query answer was produced following the clinical query protocol as described here.

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Date published: 19/04/2010


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