LASER treatment for women with high‐grade vaginal intraepithelial neoplasia: A propensity‐matched analysis on the efficacy of ablative versus excisional procedures

Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Mosca, Lavinia; Chiappa, Valentina; Rossetti, Diego; Maggiore, Umberto Leone Roberti; Sabatucci, Ilaria; Lorusso, Domenica; Raspagliesi, Francesco

doi:10.1002/lsm.22941

Cited by 33 publications

(42 citation statements)

References 17 publications

(42 reference statements)

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“…7 Low-grade VaIN has a high rate of spontaneous regression and a low risk of progression to malignancy, while high-grade VaIN has a high risk of recurrence and progression to invasive vaginal cancer. [8][9][10][11] For VaIN, different lesions require different therapeutic approaches; thus, a proper diagnosis is important. Since VaIN is often asymptomatic, its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically guided biopsy of suspicious areas.…”

Section: Introductionmentioning

confidence: 99%

<p>Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia</p>

Zhou¹,

Zhang²,

Sui³

et al. 2020

CMAR

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To evaluate the colposcopic accuracy of the detection of vaginal intraepithelial neoplasia (VaIN) according to the colposcopic terminology for the vagina from the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC). Methods: A total of 467 women who were suspected of having VaIN and underwent colposcopy at Obstetrics and Gynecology Hospital of Fudan University from January to December 2018 were included in this retrospective cohort study. The 2011 IFCPC revised terminology for the vagina was applied, and the agreement between colposcopic diagnosis and vaginal biopsy pathology was analysed. Results: Agreement between colposcopy and pathology was 69.16% (kappa=0.437, p<0.001), with 23.34% overestimated and 7.49% underestimated diagnosis for colposcopy. The agreement was the lowest (35.71%) in the high-grade VaIN group, which was significantly different from that of other lesion grade groups (p<0.01). Among grade 1 findings, thin acetowhite epithelium was the most frequent (80.51%). Grade 2 findings and vascular patterns were rare. The positive predictive values of the micropapillary pattern were 55.98% for low-grade VaIN and 5.98% for high-grade VaIN. The specificity of iodine negativity was 10.92% for low-grade VaIN and 8.30% for high-grade VaIN. There were significant differences in the maximum size of single lesions and in the number of lesions among different grade lesion groups. Conclusion: The agreement between colposcopy findings utilizing the 2011 IFCPC terminology and vaginal pathology is moderate, and more definite findings for high-grade VaIN may be needed. The micropapillary pattern can be considered an alternative low-grade finding, while iodine staining is nonspecific for all lesions. Scattered and spotty lesions suggest low-grade VaIN, while large single lesions suggest high-grade VaIN.

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Section: Introductionmentioning

confidence: 99%

<p>Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia</p>

Zhou¹,

Zhang²,

Sui³

et al. 2020

CMAR

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“…Although the diagnosis of vaginal dysplasia is increased in the recent years [789], only few studies evaluated outcomes of women affected by VaIN [8910111213141516]. There is no consensus about the optimal treatment modality for women affected by high-grade VaIN.…”

Section: Introductionmentioning

confidence: 99%

Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia

et al. 2019

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Objective We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. Methods Data of consecutive women diagnosed with recurrent high-grade vaginal intra-epithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models. Results Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range,5-42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028). Conclusion Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes.

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“…СО 2 -лазер может быть использован в качестве метода аблации и метода эксцизии, поэтому несколько авторов считают его методом выбора [9,30,34,35].…”

Section: Gynecologic Oncologyunclassified

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

Zarochentseva¹,

Krasnopolsky²,

Dzhidzhikhiya³

et al. 2020

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Цель обзора: обобщение научных данных о диагностике, лечении, профилактике влагалищных интраэпителиальных неоплазий (vaginal intraepithelial neoplasia, VAIN). Основные положения. VAIN-редкое бессимптомное предраковое заболевание. Основные факторы риска возникновения VAINинфицирование вирусом папилломы человека (ВПЧ) и ранее проведенная гистерэктомия. При диагностике применяются цитологическое исследование, ВПЧ-тестирование, вагиноскопия и биопсия. В качестве методов лечения VAIN используются CO 2-лазер, петлевая электроэксцизия, кавитационная ультразвуковая хирургическая аспирация, лучевая терапия и др. Заключение. Нельзя недооценивать опасность поражения влагалища у ВПЧ-позитивных пациенток даже после проведенной гистерэктомии. Влагалище следует исследовать во время каждой кольпоскопии. Вакцинация против ВПЧ является действенной мерой профилактики ВПЧ-ассоциированных раков и предраков, включая VAIN. Ключевые слова: интраэпителиальная неоплазия влагалища, рак влагалища, клинические проявления, фотодинамическая терапия, вакцинация, вирус папилломы человека.

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LASER treatment for women with high‐grade vaginal intraepithelial neoplasia: A propensity‐matched analysis on the efficacy of ablative versus excisional procedures

Abstract: Women affected by high-grade vaginal intra-epithelial neoplasia are at high risk of recurrence. LASER ablation seems to be equivalent to excision in term of long-term effectiveness. Lasers Surg. Med. 50:933-939, 2018. © 2018 Wiley Periodicals, Inc.

Cited by 33 publications

References 17 publications

<p>Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia</p>

<p>Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia</p>

Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

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