Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia

Jentschke, Matthias; Hoffmeister, Victoria; Soergel, Philipp; Hillemanns, Peter

doi:10.1007/s00404-015-3835-6

Cited by 48 publications

(52 citation statements)

References 22 publications

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“…In the laser vaporisation group hrHPV persisted among 67% of the patients. Persistent hrHPV infection is a risk factor for recurrent disease . We did not detect differences in histological regression between imiquimod treatment or laser vaporisation.…”

Section: Discussioncontrasting

confidence: 68%

“…Multifocality of VAIN has been previously reported in 29–51% compared with 63% in our study . Our rate of hysterectomised patients (37%) was lower than in other studies (54–88%) …”

Section: Discussioncontrasting

confidence: 67%

“…Persistent hrHPV infection is a risk factor for recurrent disease. 11,22 We did not detect differences in histological regression between imiquimod treatment or laser vaporisation. However, at baseline we detected four cases of VAIN 3 in the imiquimod group, but none in the laser group, which might have biased the results.…”

Section: Discussionmentioning

confidence: 56%

“…3,9,10,23 In our study, 77% of patients were hrHPV positive at baseline in comparison with 48-85% reported by others. 10,11,23 Of our patients 67% had been previously treated for or had concomitant HPV-related genital neoplasias while others report rates between 58% and 68%. 3,9,10 Multifocality of VAIN has been previously reported in 29-51% compared with 63% in our study.…”

Section: Discussionmentioning

confidence: 85%

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Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Tainio

Jakobsson

Louvanto

et al. 2016

Intl Journal of Cancer

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Vaginal intraepithelial neoplasia (VAIN) is associated with human papillomavirus (HPV) infection. The most common treatment modality is laser vaporisation, but recurrences are common. Imiquimod is an immune response modulator which is used for the treatment of external condylomas and other HPV-related genital neoplasias. The aim of the study was to evaluate the efficacy and tolerability of vaginally administered imiquimod in comparison with laser vaporisation and expectant management of high-grade VAIN. This proof of principle pilot study was a prospective 16-week randomised trial. We enrolled 30 patients with histologically confirmed VAIN 2 or 3 into three study arms: vaginally administered imiquimod, laser vaporisation and expectant management. Follow-up colposcopy visits included high-risk human papillomavirus (hrHPV) testing, cytology and punch biopsies. At baseline 77% (n = 20/26) of the patients were hrHPV positive. HPV clearance was significantly higher in the imiquimod arm (63%, n = 5/8) than in the laser arm (11%, n = 1/9) (p = 0.05) or in the expectant management arm (17%, n = 1/6) (p = 0.138). At baseline 25 patients (83%) had VAIN 2 and five (17%) had VAIN 3. None of the lesions progressed during the follow-up. Histological regression (≤VAIN 1) was observed in 80% (n = 8/10) of patients in the imiquimod arm, 100% (n = 10/10) of the laser arm (p = 0.474) and 67% (n = 6/9) of the expectant management arm (p = 0.628). Vaginal imiquimod appears to be as effective as laser treatment in high-grade VAIN.

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Section: Discussioncontrasting

confidence: 68%

“…Multifocality of VAIN has been previously reported in 29–51% compared with 63% in our study . Our rate of hysterectomised patients (37%) was lower than in other studies (54–88%) …”

Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 85%

See 2 more Smart Citations

Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Tainio

Jakobsson

Louvanto

et al. 2016

Intl Journal of Cancer

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show abstract

“…The vast majority (n = 19) of studies used formalin fixed paraffin embedded tissue for HPV DNA and/or p16 testing. Five studies reported using tissue samples, but did not specify tissue storage (i.e., fresh, frozen, or fixed) . In five studies, HPV DNA was extracted from exfoliated cells, and in one study, the type of material used was not reported .…”

Section: Resultsmentioning

confidence: 99%

Human papillomavirus and p16 in squamous cell carcinoma and intraepithelial neoplasia of the vagina

Bertoli

Rasmussen

Sand

et al. 2019

Intl Journal of Cancer

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We estimated the overall and type‐specific prevalence of human papillomavirus (HPV) and p16 overexpression in vaginal cancer and vaginal intraepithelial neoplasia (VaIN). We conducted a systematic search of PubMed, Embase and Cochrane Library to identify studies published between 1986 and 2017 using PCR‐based or Hybrid Capture 2 tests to evaluate the presence of HPV DNA and/or using any method to detect p16 overexpression in VaIN, vaginal squamous cell carcinoma (VaSCC), or other types of vaginal cancer. Applying a random effects model, we estimated the pooled prevalence of HPV and p16 overexpression along with 95% confidence intervals (CIs). The I2 statistic was used to assess heterogeneity. We included 26 studies, reporting HPV prevalence and six studies evaluating p16 overexpression. The pooled HPV prevalences in VaSCC (n = 593) and VaIN (n = 1,374) were 66.7% (95% CI = 54.7–77.8) and 85.2% (95% CI = 78.2–91.0), respectively. Substantial inter‐study heterogeneity was observed, and analyses stratified on geographic region, type of tissue, HPV detection method or PCR primer type did not fully explain the observed heterogeneity. The most predominant HPV type among the HPV positive VaSCC and VaIN cases was HPV16, followed by HPV33, and HPV45 (in VaIN) and HPV18, and HPV33 (in VaSCC). In pooled analyses, 89.9% (95% CI = 81.7–94.6) of HPV positive and 38.9% (95% CI = 0.9–90.0) of HPV negative vaginal cancers were positive for p16 overexpression. Our findings suggest that vaccination against HPV might prevent a substantial proportion of vaginal neoplasia and highlight the need for further studies of the possible clinical value of p16 testing in these patients.

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Vaginal Preinvasive Lesions and Vaginal Cancer

Sel

2019

Practical Guide to Oral Exams in Obstetrics and Gynecology

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Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia

Abstract: VAIN has a high relapse rate and a high progression rate to invasive cancer especially if HR-HPV positive. Therefore, adequate follow-up examinations are mandatory.

Cited by 48 publications

References 22 publications

Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Randomised trial on treatment of vaginal intraepithelial neoplasia—Imiquimod, laser vaporisation and expectant management

Human papillomavirus and p16 in squamous cell carcinoma and intraepithelial neoplasia of the vagina

Vaginal Preinvasive Lesions and Vaginal Cancer

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