Beyond the transformation zone: Outcomes in the management of CGIN over five years
Cervical Glandular Intraepithelial Neoplasia (CGIN) is the term used to describe endocervical glandular lesions that predispose to cervical adenocarcinoma. Colposcopy is an important step in the investigation and management of suspected glandular disease. Excisional biopsy is necessary given the nature of the condition, which may reside in the endocervix with no visible lesions at colposcopy. Once diagnosed, a cylindrical excision is recommended, the depth of which is dependent on age and type of transformation zone. Our aim was to analyse the management and outcomes in this cohort of patients, over a five year period. A retrospective chart review was performed in a tertiary colposcopy department over a five-year period. In total 109 patients diagnosed with CGIN were included. The incidence of CGIN was 0.95 %. The mean patient age at diagnosis with CGIN was 35.5 years (SD = 8+/-7.1). Abnormal cervical smear results were the most common reason for initial referral, with atypical squamous cells of undermined significance (ASCUS) the most frequent smear abnormality (19.3 %/n = 22). On initial colposcopic assessment, high-grade CIN was suspected in 58.7 % (n = 64) cases. An initial LLETZ (Large Loop Excision of the Transformation Zone) was performed, with clear margins achieved in 56.9 % (n = 62). A repeat LLETZ was performed in 54 % (n = 58) of cases, with clear margins achieved in 88.1 % (n = 52). Hysterectomy was ultimately performed in 15.6 % (n = 17) cases. Although cytological glandular abnormalities are significantly less common than squamous lesions, adenocarcinomas now comprise up to 25 % of cervical cancer diagnoses, which is continuing to rise. Findings from this study reinforce the critical role of comprehensive diagnostic evaluation, adequate excisional management, and structured follow-up protocols in the care of patients with cervical glandular intraepithelial neoplasia (CGIN). Despite high rates of disease resolution following treatment, ongoing surveillance is essential, as a substantial proportion of patients ultimately require definitive management with hysterectomy.