CO2 laser colposcopic guided surgery for the see and treat management of VHSIL: a preliminary experience

Abstract

The purpose of this study is to evaluate the efficiency of CO2 laser colposcopic guided surgery performed in an outpatient see and treat setting in the management of VHSIL. Women with a suspected diagnosis of VHSIL and no vulvoscopic suspicion of vSCC were enrolled. An electronic register of CO2 laser treatment was created where description of performing parameters (excision or ablation) was specified and personal history was recorded. Statistical analysis was performed by Fisher’s exact test. Relative risks (RR) of risk factor were calculated and expressed in odds. From September 2014 to September 2018, we enrolled a total of 63 patients who underwent CO2 laser procedure and had a minimum follow-up time of 2 years at Careggi University Hospital in Florence. Forty-eight (76.2%) patients underwent laser excision and 15 (23.8%) patients underwent ablative treatment without histological results. Undertreatment was performed in 3 cases (6.3%) with definitive histology of vSCC. Therapeutical appropriateness of CO2 laser excision was reached in 85.4% of the cases (41/48). No volunteer loss to follow-up was registered; thus, fidelity to treatment was assess at 100%. Recurrence rate within 2 years attested in 8/60 followed patients (13.3%). No personal factor was found to influence the VHSIL course. CO2 laser excision may represent an excellent therapeutic option to VHSIL because it provides adequate oncological purpose with good cosmetic and functional results and high patients’ loyalty to treatment. An expert team could allow to undergo patients with VHSIL suspicion to unique diagnostic and therapeutic procedure with significant benefits.

Clinical and Pathological Features in Women with Vulvar Squamous Intraepithelial Neoplasia: A Single Center Experience from China

“…The goals for VIN treatment should be to completely destroy the lesion, improve symptoms, exclude invasion, preserve normal vulvar anatomy and function, and avoid recurrences [24] . VIN has a recurrence rate of 20-36.7% despite treatment [25,26] , with 2-15% progressing to vulvar cancer [27,28] . The risk factors for the recurrence and progression of VIN remain poorly understood.…”

Vulvar squamous intraepithelial neoplasia epithelial thickness in hairy and non-hairy sites: a single center experience from China

“…VIN treatment aims to completely destroy the lesion, improve symptoms, exclude invasion, preserve normal vulvar anatomy and function, and avoid recurrence ( 3 ). VIN has a recurrence rate of 20–36.7% despite treatment ( 24 , 25 ), with 2–15% of cases progressing to vulvar cancer ( 26 , 27 ). The risk factors for recurrence and progression of VIN remain poorly understood.…”