Precise Measurement of the Thickness of Vaginal Intraepithelial Neoplasia

Abstract

ObjectivesAlthough carbon dioxide laser vaporization is frequently used for treating vaginal intraepithelial neoplasia (VaIN), the optimal depth of epithelial destruction with laser vaporization requires elucidation. We aimed to evaluate VaIN depth and better illustrate epithelial destruction during laser vaporization.Materials and MethodsWe included 246 women diagnosed with VaIN (low-grade VaIN [VaIN 1], 123 women; high-grade VaIN [VaIN 2/3], 123 women) using colposcopy-directed biopsy at our hospital from January 1, 2019, to April 30, 2020. The thickness of the noninvolved epithelium, if available, was determined. All available data, including cytology and histological information, were recorded. The t test and Pearson χ2 test were used for statistical analysis. Statistical significance was set at p < .05.ResultsThe involved epithelial thicknesses in VaIN 2/3 and VaIN 1 were 0.41 ± 0.21 and 0.40 ± 0.19 mm, respectively, which were both greater than their noninvolved epithelial thickness values (0.17 ± 0.10 and 0.17 ± 0.08 mm, p < .01 and p < .01, respectively). In subgroup comparisons between the VaIN 2/3 and VaIN 1 groups, the involved epithelial thickness did not differ between premenopausal patients, postmenopausal women receiving estrogen, and postmenopausal women who did not receive estrogen (p > .05). In the VaIN 2/3 group, the lesion thickness in premenopausal was greater than that in postmenopausal women receiving estrogen (p = .016) and those who were not receiving estrogen (p = .017).ConclusionsThe thickness of VaIN is generally less than 1 mm for women of all ages, except in rare cases of visible lesions with papillary hyperplasia.

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

“…Exploring the depth of the involved and non-involved vaginal epithelium in 246 patients with VaIN, Cui et al found that the thickness of the lesion was generally <1 mm for patients of all ages, except in rare cases of visible lesions with papillary hyperplasia. The mean thickness of the epithelium involved was 0.4 mm and it did not differ between the grades of VaIN 80 …”

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

“…The mean thickness of the epithelium involved was 0.4 mm and it did not differ between the grades of VaIN. 80 CO 2 laser vaporization can be performed under local anesthesia. Epithelial destruction to a depth of 1-1.5 mm, including the zone of thermal necrosis, seems to be sufficient to destroy the epithelium containing SIL, without damage to the underlying structures.…”

“…The mean thickness of the epithelium involved was 0.4 mm and it did not differ between the grades of VaIN. 80 …”

Key Points of the European Communities Consensus Statement on the Treatment of Vaginal Intraepithelial Neoplasia

“…Средняя толщина пораженного эпителия составляла 0,4 мм и не различалась в зависимости от степени VaIN по результатам Cui C. с соавт. [62]. CO 2 -лазерная вапоризация может проводиться под местной анестезией.…”