Detection of high‐risk human papillomavirus infection and treatment of high‐grade vaginal intraepithelial neoplasia: A single‐institution study

Cho, Hyun-Woong; Lee, Jae Kwan

doi:10.1002/ijgo.13583

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…It has been reported that there is a positive correlation between the grade of VaIN and grade of concomitant CIN, although there is a non-negligible number of women in whom vaginal lesions were found to be more severe than cervical lesions [ 52 ]. As especially HPV 16 and HPV 31 were found to be highly associated with high-grade VaIN, it is advisable to be particularly attentive for signs of VaIN among patients tested positive for these hrHPV subtypes [ 53 ]. However, to add another degree of complexity, recent data suggests that concomitant CIN and VaIN in the same patient develop independently, since in the great majority of cases different hrHPV types were identified within the cervical and vaginal lesions [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany

Berger

Wolf-Breitinger

Weiß

et al. 2023

Cancer Causes Control

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Purpose According to the recently implemented organized cervical cancer screening program in Germany, women older than 35 years with negative cytology but persistent high-risk human papilloma virus (hrHPV) infection > 12 months should be referred to colposcopy for further evaluation. This study aimed to present and dissect colposcopic and histopathological findings with particular focus on associated hrHPV genotypes. Methods This study is a retrospective analysis of clinical data from 89 hrHPV positive patients with normal cytology who underwent colposcopic examination at a certified dysplasia outpatient clinic in Germany in 2021. Results While 38 (43%) women had a normal colposcopic finding, 45 (51%) had minor and 6 (7%) major changes. Thirty-one (35%) of the women were HPV 16 and/or HPV 18 positive and 58 (65%) women were positive for other hrHPV only. Among patients who underwent colposcopy with biopsies (in case of an abnormal finding or type 3 transformation zone, n = 68), eight (12%) had cervical intraepithelial neoplasia (CIN) 3 and six (9%) had CIN 2. The proportion of women diagnosed with CIN 3 varied among different hrHPV genotypes (HPV 16: 11%, HPV 18: 33%, HPV 31: 27%, HPV 33: 33%, HPV 52: 33%). Conclusion Persistently hrHPV positive women with negative cytology are at increased risk of being diagnosed with CIN 3. As CIN 3 prevalence seems to differ with regard to hrHPV strain, immediate HPV genotyping for risk stratification and subsequent early referral for colposcopy might constitute a feasible strategy.

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Section: Discussionmentioning

confidence: 99%

Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany

Berger

Wolf-Breitinger

Weiß

et al. 2023

Cancer Causes Control

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“…And most of them are considered to be skip lesions rather than a contiguous lesion, because 3 out of 4 VaIN3 recurrent cases are margin negative at the initial surgery. As for VaIN 3, HPV 16, 31 and 52 have been reported to be more involved in its development, 14,[21][22][23] which are slightly different from CIN2/3 (HPV 16 and 18 dominant). It is possible that subtle differences regarding hrHPV may be involved.…”

Section: Discussionmentioning

confidence: 99%

High‐grade vaginal intraepithelial neoplasia after hysterectomy for high‐grade cervical intraepithelial neoplasia: Is hysterectomy a “definitive” treatment compared to conization?

Tanaka

Yamanoi

Taki

et al. 2023

J of Obstet and Gynaecol

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AimWe investigated the frequency of early recurrence of vaginal intraepithelial neoplasia grade 2/3 (VaIN 2/3) (within 2 years) after hysterectomy for cervical intraepithelial neoplasia grade 3 (CIN3). The characteristics of the clinicopathological factors common to them were explored including different surgical methods.MethodsAs a retrospective observational study, a total of 647 CIN3 patients were divided into a conization and hysterectomy group (C group, n = 492; H group, n = 155), and HSIL (CIN2/3 or VaIN2/3) recurrence within 2 years after surgery was evaluated. A stratified analyses was performed. Surgical methods were divided into trans‐abdominal, trans‐vaginal, and laparoscopic.ResultsThe recurrence of VaIN3 was detected in four cases (2.6%) in the H group, which was similar to that of CIN2/3 in the C group, 12 out of 491 patients (2.4%). The patients who developed VaIN3 were significantly older than those who did not (median, VaIN3: 71.0; VaIN1 and less: 48.0; p < 0.0001). All VaIN3 cases were detected within 5 months, although majority of cases were negative in the margin (3/4 cases; margin negative). The method of hysterectomy was not related to the VaIN3 recurrence.ConclusionFor CIN3 patients for whom hysterectomy is the main treatment, VaIN3 can develop in 2.6% within very shortly after operation even if surgical margin was negative. The elder the age, the higher the risk of early recurrence could be. Laparoscopic surgery is considered to be acceptable methods of hysterectomy.

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“… 81 In a retrospective review of 389 patients, those who underwent primary laser therapy, brachytherapy, or vaginectomy experienced high rates of remission in histopathologic follow-up (73.7%, 71.4%, and 100%, respectively) and similar rates of hr-HPV clearance (52.6%, 57.1%, and 50.0%, respectively). 114 …”

Section: Methodsmentioning

confidence: 99%

“…There was also no significant influence in the relapse rate by VaIN grading, simultaneous CIN or vulvar intraepithelial neoplasia, previous therapy, or history of hysterectomy 81 . In a retrospective review of 389 patients, those who underwent primary laser therapy, brachytherapy, or vaginectomy experienced high rates of remission in histopathologic follow-up (73.7%, 71.4%, and 100%, respectively) and similar rates of hr-HPV clearance (52.6%, 57.1%, and 50.0%, respectively) 114 …”

Section: Methodsmentioning

confidence: 99%

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia

Kesić

Carcopino

Preti

et al. 2023

J Low Genit Tract Dis

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The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vaginal intraepithelial neoplasia (VaIN). The management of VaIN varies according to the grade of the lesion: VaIN 1 (low grade vaginal squamous intraepithelial lesions (SIL)) can be subjected to follow-up, while VaIN 2–3 (high-grade vaginal SIL) should be treated. Treatment needs individualization according to the patient’s characteristics, disease extension and previous therapeutic procedures. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Total vaginectomy is used only in highly selected cases of extensive and persistent disease. Carbon dioxide (CO 2 ) laser may be used as both an ablation method and an excisional one. Reported cure rates after laser excision and laser ablation are similar. Topical agents are useful for persistent, multifocal lesions or for patients who cannot undergo surgical treatment. Imiquimod was associated with the lowest recurrence rate, highest human papillomavirus (HPV) clearance, and can be considered the best topical approach. Trichloroacetic acid and 5-fluorouracil are historical options and should be discouraged. For VaIN after hysterectomy for cervical intraepithelial neoplasia (CIN) 3, laser vaporization and topical agents are not the best options, since they cannot reach epithelium buried in the vaginal scar. In these cases surgical options are preferable. Brachytherapy has a high overall success rate but due to late side effects should be reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments. VaIN tends to recur and ensuring patient adherence to close follow-up visits is of the utmost importance. The first evaluation should be performed at 6 months with cytology and an HPV test during 2 years and annually thereafter. The implementation of vaccination against HPV infection is expected to contribute to the prevention of VaIN and thus cancer of the vagina. The effects of treatment can have an impact on quality of life and result in psychological and psychosexual issues which should be addressed. Patients with VaIN need clear and up-to-date information on a range of treatment options including risks and benefits, as well as the need for follow-up and the risk of recurrence.

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Detection of high‐risk human papillomavirus infection and treatment of high‐grade vaginal intraepithelial neoplasia: A single‐institution study

Cited by 9 publications

References 28 publications

Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany

Prevalence of higher-grade dysplasia in persistently high-risk human papillomavirus positive, cytology negative women after introduction of the new cervical cancer screening in Germany

High‐grade vaginal intraepithelial neoplasia after hysterectomy for high‐grade cervical intraepithelial neoplasia: Is hysterectomy a “definitive” treatment compared to conization?

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