Colposcopic Imaging Features and Missed Diagnoses in Cervical Adenocarcinoma In Situ: A Retrospective Study

Abstract Background Cervical adenocarcinoma in situ (AIS) is difficult to diagnose during colposcopy due to its unusual appearance. There's a lack of literature on AIS in colposcopic imaging. Method In this retrospective study, data from patients at the Obstetrics and Gynecological Hospital of Fudan University from Jan 2019 to Dec 2023 were analyzed. Patients who were diagnosed with AIS through pathological examination following colposcopy were included. Data collected included patient age, cytological results, HPV results obtained within six months prior to colposcopy, colposcopic images, medical records, and pathology reports, as well as the results of the loop electrosurgical excision procedure (LEEP), if available. The study aimed to analyze clinical characteristics, colposcopic image features, and the causes of missed diagnoses during colposcopy. Results A total of 181 cases with a pathological diagnosis of AIS from colposcopy were included.Among the cases, 46.4% had NILM cytology, 17.1% showed AGC/AIS, and 84.5% were HPV 16/18+. Image reviews highlighted acetowhite epithelium and atypical vascular patterns. Reasons for missed diagnoses included lack of familiarity (43.9%) and inadequate visualization (24.4%). Cases with NILM cytology were more frequently missed, while non-missed cases had clearer lesion boundaries and a higher prevalence of AIS in both the cervix and canal Conclusion The presence of atypical colposcopic images in AIS patients heightens the risk of diagnostic oversight. By examining the colposcopic image characteristics of AIS patients, standardizing colposcopy procedures to ensure proper exposure of the cervix, and conducting endocervical curettage in non-pregnant women, the rate of missed diagnoses in AIS patients during colposcopy can be effectively decreased.