Marco Bernardi

Background: The approach to adenocarcinoma in situ (AIS) is challenged by diagnostic complexity, limited high-quality evidence, and heterogeneous guidance. Methods: We conducted a narrative comparative review of global guidelines/recommendations (2012–2025; search updated 1 October 2025), extracting data across 38 topics related to AIS management and classifying indications into five categories of coverage/consensus. Results: Twenty documents from national or supranational bodies were included. A cross-guideline consensus emerged on eight core items (colposcopy for any glandular cytologic abnormality; role of HPV test; mandatory histologic confirmation; excisional treatment for histologic AIS; re-excision when margins are involved; criteria and type of hysterectomy; and expert/centralized management). Operational variability emerged in the excisional technique, pathways for discordant results, management during pregnancy, and follow-up protocols. Divergent guidance was most evident for indications to endocervical sampling, criteria for conservative management, and the need for hysterectomy after completed childbearing. Limited-coverage consensus involved the technique of initial histologic sampling, endometrial assessment, and pathways for cytology subtypes. Several areas remained unaddressed. Conclusions: While the essential management of AIS is well defined, uncertainty increases when treatment must be personalized. A core outcome set and rigorous multicenter studies are needed to reduce heterogeneity and enable truly evidence-based personalization.

Background/Objectives: The objective of this systematic review and meta-analysis was to compare the risk of recurrence and residual disease between conservative and demolitive treatment in patients diagnosed with cervical adenocarcinoma in situ (AIS). Methods: Bibliographic databases (CENTRAL, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar) were searched for studies published up to December 2024 reporting both conservative and demolitive treatment outcomes. Exclusion criteria were the lack of outcomes of interest, the reporting of only one treatment modality, and a lack of follow-up. The ROBINS-I tool was used to assess the risk of bias. The evaluated outcomes were AIS or invasive recurrence and AIS or invasive residual after margin positivity at the first excision. A meta-analysis with a fixed-effect model and the Mantel–Haenszel method for risk ratio (RR) with a 95% confidence interval (CI) was performed. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed using the year of publication, CKC use, margin positivity, and follow-up duration as predictors. Results: Nineteen studies were included, reporting data about 5934 patients with AIS diagnosis after conization. The meta-analysis showed a higher risk of recurrence as AIS in conservatively treated patients (11 studies, RR = 8.44, 95% CI 3.36–21.19, p < 0.001, I2 = 0.0%, p = 0.73), while no differences were observed in the risk of recurrence as invasive adenocarcinoma (10 studies, RR = 1.67, 95% CI 0.82–3.39, p = 0.16, I2 = 0.00%, p = 0.48). No difference between the two treatment modalities in terms of AIS residual (nine studies, RR = 0.89, 95% CI 0.62–1.26, p = 0.50, I2 = 33%, p = 0.15) or invasive residual (three studies, RR = 0.48, 95% CI 0.09–2.41, p = 0.37, I2 = 0.0%, p = 0.94) after margin positivity at the first excision emerged. The meta-regression showed no association with the predictors. Conclusions: The safety profile of a conservative treatment for AIS patients seems not to differ from that of a demolitive approach in terms of invasive recurrence or residual, while it seems to be associated with a higher risk of AIS recurrence. Future research should focus on optimizing follow-up strategies to detect AIS recurrences early.

Surgery is the cornerstone of vulvar cancer treatment, but it is associated with a significant risk of complications that may impact prognosis, particularly in older patients with multiple comorbidities. The objective of this study was to evaluate the role of age, comorbidities, and frailty in predicting postoperative complications after vulvar cancer surgery and to develop a predictive nomogram. A retrospective cohort study was conducted, including patients who underwent surgery for vulvar cancer at two Italian institutions from January 2018 to December 2023. A logistic regression model for the rate of Clavien-Dindo 2+ 30-days complications was run, considering the age-adjusted Charlson Comorbidity Index (AACCI), body mass index (BMI), and frailty as exposures. Lesion characteristics and surgical procedures were considered as confounders. Among the 225 included patients, 50 (22.2%) had a grade 2+ complication. The predictive score of the nomogram ranged from 44 to 140. The AACCI (0–64 points) and BMI (0–100 points) were independently associated with a risk of complications. A nomogram including the AACCI and BMI predicts the risk of complications for patients undergoing surgery for vulvar cancer. The preoperative determination of the risk of complications enables surgical planning and allows a tailored peri- and postoperative management plan.