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

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.