Combination of surgical excision and carbon dioxide laser vaporization for multifocal vulvar intraepithelial neoplasia

Bornstein, Jacob; Kaufman, Raymond H.

doi:10.1016/0002-9378(88)90004-x

Cited by 17 publications

(7 citation statements)

References 15 publications

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“…Le risque de récurrence est important pouvant aller jusqu'à 30 à 40 % des cas quel que soit le type de traitement [8][9][10][11][12]32]. Trois principaux facteurs dans notre étude influençaient la survenue d'une récurrence : la multifocalité, l'existence d'une micro-invasion à l'analyse histologique de la pièce opéra-toire et l'atteinte des marges d'exérèse.…”

Section: Discussionunclassified

“…Les auteurs anglosaxons ne font pas cette distinction clinique et considèrent l'ensemble des VIN3 mais restent partagés sur l'évolution. Une récurrence est retrouvée pour 10 à 40 % des patientes [8][9][10][11] et une évolution vers le carcinome invasif dans environ 5 % des cas [12,13]. À l'inverse, des cas de régressions spontanées ont été décrits pour des lésions de petite taille concernant des patientes jeunes [14,15].…”

Section: Introductionunclassified

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Étude clinique et pronostic de 56 cas de néoplasies intraépithéliales vulvaires

Deruelle

Deruelle-Khazaal

Collinet

et al. 2005

Gynécologie Obstétrique & Fertilité

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Section: Discussionunclassified

Section: Introductionunclassified

Étude clinique et pronostic de 56 cas de néoplasies intraépithéliales vulvaires

Deruelle

Deruelle-Khazaal

Collinet

et al. 2005

Gynécologie Obstétrique & Fertilité

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“…Vulvoscopy is being used nowadays in the evaluation of vulvar complaints and pathology 6,7 , in the diagnostic work‐up of women with abnormal PAP smears 24 , and in the treatment of VIN III to remove all vulvoscopically visible lesions 8–10 . However, the true value of vulvoscopy has not been systematically tested.…”

Section: Discussionmentioning

confidence: 99%

“…The vulvoscope (i.e. colposcopy of the vulva) was introduced to aid evaluation of vulvar complaints 6,7 and has been used in the management of vulvar intraepithelial neoplasia (VIN) to remove all visible lesions 8–10 . The colposcope was introduced in the evaluation of abnormal cervical cytology because the colposcopic image has been proven reliable in the prediction of histological alterations 11 .…”

Section: Introductionmentioning

confidence: 99%

Normal findings in vulvar examination and vulvoscopy

Beurden

Vange

Craen

et al. 1997

BJOG

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Objective To determine the normal vulvar findings by naked eye examination and by vulvoscopy in Design Observational study. Population Forty healthy volunteers without vulvar complaints recruited via a newspaper advertisement.Methods Vulvar examination, human papillomavirus (HPV) polymerase chain reaction of vulvar and cervical swabs, saline and KOH smears and vulvoscopy before and after the application of 5% acetic acid. Main outcome measuresPrevalence of vestibular erythema, vestibular papillomatosis, HPV infection on the vulva and in the cervix and vulvoscopic findings. ResultsThe mean age of the women was 37.8 years (median 38.0, range 21-56). Nine women were current smokers and 2 1 had previously smoked. Naked eye vulvar examination showed vestibular papillomatosis in 13 women (33%) and vestibular erythema in 17 women (43%). The touch test was positive in 9 of the 17 women (53%) with vestibular erythema. Vulvoscopy after the application of acetic acid 5% showed an acetowhite vestibule in all women. Twelve women (30%) had acetowhite lesions outside the vestibule. Six women (15%) were positive for HPV DNA. The presence of HPV DNA did not correlate with vestibular erythema or vestibular papillomatosis. There was a weak association between HPV DNA and acetowhite lesions outside the vestibule ( P = 0.055, Fisher's exact test). In this group the younger women significantly more often had vestibular papillomatosis (t-statistic = 3.07; P = 0.003) and women who smoke more often had a genital HPV infection ( P = 0.016, Fisher's exact test).Conclusions Vestibular erythema, vestibular papillomatosis, and acetowhite lesions are common in this group of healthy women without vulvar complaints.healthy women without vulvar complaints. and has been used in the management of vulvar intraepithelial neoplasia (VIN) to remove all visible lesions8-l0. The colposcope was introduced in the evaluation of abnormal cervical cytology because the colposcopic image has been proven reliable in the prediction of histological alterationsll. Although the classification of vulvoscopically visible lesions is the same as the one used for colpo~copy'~, it is uncertain whether vulvoscopy has the same predictive value as colposcopy. This is mainly because the normal distribution of vulvoscopic findings has not been determined in women without vulvar complaints and therefore one cannot distinguish between physiology and pathology. INTRODUCTIONThe aim of this study was to determine the normal vulvar findings by naked eye examination and by vulvoscopy in healthy women without vulvar complaints to obtain a reference value for vulvar examination 320 0 RCOG 1997 British Journal of Obstetrics and Gynaecologyand vulvoscopy in the diagnostic work-up of women with vulvar complaints. METHODSVolunteers were recruited via an advertisement in a national newspaper. They were eligible if they were between 20 and 60 years old, if they were healthy and if they did not have vulvar pruritus, vulvodynia, dyspareunia or known vulvar abnormalities. The approval for this...

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“…has led to a bias towards more conservative treatment for VIN and radical vulvectomies are no longer an acceptable form of treatment for younger women who wish to maintain vulval integrity. Current treatment options favour wide local excision or laser therapy, but the former has been associated with a high incidence of recurrence and the latter is not available in many centres and requires considerable expertise to keep morbidity and scarring to a minimum [3]. In 1980, deLanza et al standardized an effective cryosurgical treatment schedule for cutaneous Bowens disease (carcinoma in situ) [4].…”

Section: Introductionmentioning

confidence: 99%

Failure of cryosurgery to eradicate vulval intraepithelial neoplasia: a pilot study

Marren

Dawber

Wojnarowska

et al. 1993

Acad Dermatol Venereol

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Objective A pilot study to determine the efficacy of cryosurgery for the treatment of vulvar intraepithelial neoplasia (VIN) using a standardized treatment schedule. Background Cryosurgery is known to be an effective epithelial cell killer in cutaneous neoplasia and pre-neoplasia at other sites. It is widely available, inexpensive and most importantly does not cause the disfigurement and scarring of other treatment modalities. Setting The Vulva Clinic, John Radcliffe Hospital, Oxford, England, UK. Design Ten consecutive patients with VIN were selected from the outpatient clinic. Patients were evaluated and biopsied prior to therapy. The entire vulva and perineum was subjected to a single freeze-thaw cycle of 30 s. Patients were observed for 12 months and repeat biopsies were done at 6 and 12 months. Results Seven of eight patients with VIN Grade III had clinical and histological evidence of recurrence within 12 months and two patients with VIN Grade I had no sustained symptomatic relief. Conclusion No effective cryosurgical treatment schedule has yet been established for VIN. Our efforts to find one must continue because of the advantages of this treatment modality. Introductionmay be rising and is now being encountered in relatively young women [1,2]. It is generThere is some evidence that the prevaally believed that the risk of VIN I or VIN II lence of vulval intraepithelial neoplasia (VIN) evolving into an invasive carcinoma is small. It is also believed that the biological behaviour of VIN III is not comparable to -, r. r. •• w .-cervical intraepithelial neoplasia III (CIN III)

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Combination of surgical excision and carbon dioxide laser vaporization for multifocal vulvar intraepithelial neoplasia

Cited by 17 publications

References 15 publications

Étude clinique et pronostic de 56 cas de néoplasies intraépithéliales vulvaires

Étude clinique et pronostic de 56 cas de néoplasies intraépithéliales vulvaires

Normal findings in vulvar examination and vulvoscopy

Failure of cryosurgery to eradicate vulval intraepithelial neoplasia: a pilot study

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