Objective: To compare the safety between conization alone and hysterectomy for patients with adenocarcinoma in situ (AIS) of the cervix. Design: A cohort study of AIS patients during 2007-2021. Setting: Women’s Hospital of Zhejiang University School of Medicine. Population: A total of 453 AIS patients diagnosed by conization who underwent cervical conizations only (n=153) or conization followed by hysterectomy(n=300). Methods: The clinicopathological and follow-up data were reviewed. Univariate analysis was examined by chi-square test and multivariate analysis was performed by logistic regression analysis. Main outcome measure: The rates of residual disease in specimens of hysterectomy and repeated conization were compared between positive and negative margin of conization. And the rates of recurrence were compared between patients treated by conization(s) alone and hysterectomy. The factors influencing residual disease and recurrence were assessed, respectively. Results: Among 310 specimens of hysterectomy or repeated conization, the rates of residual disease were 50.56% (45/89) for positive margin and 2.26% (5/221) for negative margin, with a significant difference (p=0.000). Totally 4 patients recurred as vaginal intraepithelial neoplasia（VAIN）in those treated by hysterectomy and 1 recurred as cervical squamous intraepithelial neoplasia (CIN) in those treated by conization(s) alone. The rates of recurrence were 0.65% (1/153) for conization(s) alone and 1.33 % (4/300) for hysterectomy, with no significant difference (p=0.431). Hysterectomy was a factor influencing neither residual disease nor recurrence. Conclusions: Conization is an effective and safe option for patients with AIS of the cervix, provided the margin is negative. Keywords: adenocarcinoma in situ, conization, hysterectomy, margins.

Objective: To assess the clinical performance of the human papillomavirus (HPV) 16 18/45 genotype assay (AHPV-GT) combined with age stratification in triaging women with histologic low-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grade 1 (LSIL [CIN1]) preceded by HPV E6/E7 mRNA assay (Aptima HPV, AHPV) positive/normal or mildly abnormal cytology. Design: Longitudinal study. Setting: Gynaecological clinic in Huzhou Maternity & Child Health Care Hospital, China. Population: Women aged ≥21 years with histologic LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology. Methods: Women underwent AHPV-GT testing at baseline and were followed at 6-month intervals for up to 2 years. At each follow-up, women with abnormal cytology or AHPV positivity were referred for colposcopy and then biopsy if indicated. Main outcome measures: The 2-year cumulative incidence rates (CIRs) of CIN3+ stratified by baseline AHPV-GT genotyping. Results: Of 349 eligible women, 25 women (7.2%) progressed, 301 (86.2%) regressed, and 23 (6.6%) persisted during the follow-up. The 2-year CIRs of CIN3+ in AHPV-GT-positive women were both significantly higher than those in AHPV-GT-negative women overall (8.6% vs. 1.7%, P = 0.014) and in the ≥25-year-old group (10.9% vs. 1.5%, P = 0.002) but slightly higher in the 21–24-year-old group ( P > 0.05). Conclusions: AHPV-GT testing with age stratification is effective for triaging women with histologic LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology. Immediate treatment is a rational recommendation for women ≥ 25 years old with histologic LSIL (CIN1) preceded by AHPV-GT positivity when good surveillance is not assured.

How important is the hCG value for predicting dactinomycin failure after methotrexate failure for the low-risk gestational trophoblastic neoplasia: a commentary.hCG for predicting dactinomycin failure in ChinaXiaodong Wu,1 Weiguo Lu,1,2Tao Shen,1Weidong Fei, 3 Lili Chen,1 Xing Xie,1,4 Jiale Qin,2,5 1Department of Gynecologic Oncology, Women’s Hospital, School of Medicine Zhejiang University, Hangzhou, China2Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, China3Department of pharmaceutics, Women’s Hospital, School of Medicine Zhejiang University, Hangzhou, China4Women’s Reproductive Health Research Laboratory of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China5Department of Ultrasound, Women’s Hospital, School of Medicine Zhejiang University, Hangzhou, ChinaCorrespondence to: Jiale Qin, PhDAddress: Department of Ultrasound, Women’s Hospital, Zhejiang University School of Medicine, No. 1, Xueshi Road, Hangzhou 310006, ChinaTelephone number: 86-0571-87061501E-mail: [email protected]