Vaginal Intraepithelial Neoplasia: A Retrospective Study of Treatment and Outcomes Among a Cohort of UK Women

Abstract

Objectives The aim of the study was to analyze the clinical features of women found to have vaginal intraepithelial neoplasia (VaIN), the treatment modalities that they were offered, and clinical outcomes after treatment and follow-up. Materials and Methods This is a retrospective review of all cases of biopsy-proven or treated VaIN occurring for a 15-year period at Southend University Hospital, United Kingdom. Results Eighty-eight cases of VaIN were identified. The age range was from 24 to 76 years, and 39% of cases were low grade (VaIN 1) and 60% high grade (VaIN 2 and 3). Sixty-five percent of patients had either already undergone or would go on to have treatment for cervical intraepithelial neoplasia. Of those with low-grade disease, 86% were managed conservatively with a 97% success rate. Similarly, with high-grade disease, 77% were managed with laser treatment with a success rate of 76% for primary treatment. Of the 6 cases of high-grade disease treated conservatively, 50% subsequently needed active treatment. There was 1 case of progression to vaginal cancer (1.3%). Conclusions Vaginal intraepithelial neoplasia remains an uncommon premalignant condition. It can affect women of all ages and is commoner in those who are immunosuppressed. Observation of low-grade disease is safe and the abnormality often resolves spontaneously. For persistent disease or higher-grade abnormalities, there are many treatment options but laser vaporization is the most commonly used. However, because of the nature of VaIN, recurrence is common even after treatment and further management can be challenging. The overall rate of malignant progression is small but protracted follow-up may be necessary.

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

“…The relationship between hysterectomy and vaginal lesions has been previously studied, but different results have been obtained. 24,26,27 In the present study, there were significant differences in the proportion of patients who underwent hysterectomy among different grade lesion groups, and the carcinoma group had the highest proportion, followed by the HSIL group. Hence, close follow-up and careful screening may still be needed for posthysterectomy patients because of the high proportion of high-grade lesions or above in our results.…”

Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients

“…For the recurrence rate of VIN, the literature reports are quite different in the previous studies, and there was no significant relationship between disease normalization and treatment. [20][21][22] In our study, 78% of women experienced disease remission after initial treatment, and 17% of women experienced disease recurrence or persistent disease; a total of 2% of patients developed vaginal cancer, but no deaths occurred during the study period. There was no significant association between treatment type and risk of recurrence or progression among cases of high-grade VAIN, this finding was consistent with that of previous studies.…”

Vaginal intraepithelial neoplasia – a difficult diagnostic and therapeutic problem

“…Do rozwoju śródnabłonkowej neoplazji pochwy oraz inwazyjnego raka pochwy często prowadzi przetrwała infekcja HPV, wywołana wirusem brodawczaka ludzkiego wysokiego ryzyka (high-risk human papillomavirus, HR-HPV) (10) , czyli między innymi genotypami HPV 16,18,31,33,35,39,45,51,52,56,58,59 i 68 (1) . Przetrwała infekcja HR-HPV prowadzi do rozwoju stanów przednowotworowych oraz nowotworów szyjki macicy, odbytu, penisa, pochwy i sromu, a także okolicy ustno-gardłowej, w tym języka oraz migdałków (1) .…”

“…Persistent HPV infection caused by high-risk human papillomavirus (HR-HPV) (10) , i.e. HPV types 16,18,31,33,35,39,45,51,52,56,58,59 and 68, often leads to VaIN (1) . Persistent HR-HPV infection leads to precancerous conditions as well as cervical, anal, penile, vaginal, vulvar, oropharyngeal and tonsillar cancer (1) .…”