High‐grade vaginal intraepithelial neoplasia: can we be selective about who we treat?

Abstract

Objective To determine the role of conservative management in high-grade vaginal intraepithelial neoplasia (HG VaIN).Design Retrospective observational study.Setting Northern Gynaecological Oncology Centre, Gateshead, UK.Population A total of 100 women with histologically-proven HG VaIN.Methods Review of patient records from 1995 to 2011.Main outcome measures Rates of progression to cancer, treatment remission, and disease recurrence, particularly posttreatment when vaginoscopy is normal but cytology is abnormal.Results Of 100 women referred, 69 underwent initial treatment of whom 47 (68%) went into remission: of these, seven developed a recurrence after a median follow-up of 29 months (range 15-214 months). Of the 31 women managed conservatively with cytological and vaginoscopic surveillance, no cancers developed after a median follow-up of 35 months (range 2-230 months). Rate of overall progression to cancer was 3% and all were detected among the initial treatment group after a median of 59 months (range 8-249 months). Post-treatment, when normal vaginoscopy was accompanied by abnormal cytology, two categories existed. Of 24 cases with low-grade cytological abnormality, recurrence of HG VaIN occurred in seven (29%) after a median follow-up of 12 months (range 2-110 months). Of 19 cases with HG cytological abnormality, 15 (79%) developed recurrence at a median follow-up of 7 months (range 2-21 months), giving a hazard ratio 5.6 (95% confidence interval 2.0-15.5, P = 0.001).Conclusions It is possible to select women with HG VaIN for conservative surveillance with excellent results. The majority of women undergoing initial treatment will enter remission. Posttreatment, if cytological abnormality develops in the presence of normal vaginoscopy, the majority of women will develop histological HG VaIN recurrence.

Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia

“…In this study, 6 % of the included women had or developed vaginal cancer, which is in the range of other reports [8][9][10]. All of these cases were HR-HPV positive, all primarily had VAIN grade 3.…”

“…This may be the case because of a very liberal definition of relapse in this study (abnormal cytology, suspicious colposcopy). This definition was used as abnormal cytology after treatment is often a sign for VAIN recurrence [10]. Other studies only considered histologically confirmed VAIN as relapse.…”

Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors

“…Squamous cell carcinoma of the vagina can be preceded by vaginal intraepithelial neoplasia [VAIN], but the true malignant potential of VAIN is still unknown [6,[17][18][19]. VAIN has been sometimes detected in women with prior radiotherapy for gynecological malignancies [20].…”

Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer

“…Although the overall risk of invasive progression is only approximately 3% [10], physicians need to be mindful of underestimating larger lesions with malignant potential. Additional factors to consider when selecting the appropriate treatment for women with VaIN include prior hysterectomy, prior radiation therapy, age, sexual activity, comorbidities and vaginal anatomy [11].…”