Surgical interventions for high grade vulval intraepithelial neoplasia

Abstract

Background Vulval intraepithelial neoplasia (VIN) is a pre-malignant condition of the vulval skin. This uncommon chronic skin condition of the vulva is associated with a high risk of recurrence and the potential to progress to vulval cancer. The condition is complicated by its’ multicentric and multifocal nature. The incidence of this condition appears to be rising particularly in the younger age group. There is a lack of consensus on the optimal surgical treatment method. However, the rationale for surgical treatment of VIN has been to treat symptoms and exclude underlying malignancy with the continued aim of preservation of vulval anatomy and function. Repeated treatments affect local cosmesis and cause psychosexual morbidity thus impacting on the patients’ quality of life. Objectives To evaluate the effectiveness and safety of surgical interventions for high grade VIN. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Issue 3, 2010, Cochrane Gynaecological Cancer Group Trials Register, MEDLINE and EMBASE up to September 2010. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) that compared surgical interventions, in adult women diagnosed with high grade vulval intraepithelial neoplasia. Data collection and analysis Two review authors independently abstracted data and assessed risk of bias. Main results We found only one RCT which included 30 women that met our inclusion criteria and this trial reported data on carbon dioxide laser (CO2 laser) versus ultrasonic surgical aspiration (USA). There was no statistically significant difference in the risk of disease recurrence after one year follow-up, pain, presence of scarring, dysuria or burning, adhesions, infection, abnormal discharge and eschar between women who received CO2 laser and those who received USA. The trial lacked statistical power due to the small number of women in each group and the low number of observed events, but was at low risk of bias. Authors’ conclusions The included trial lacked statistical power due to the small number of women in each group and the low number of observed events. Therefore in the absence of reliable evidence regarding the effectiveness and safety of the two surgical techniques for the management of vulval intraepithelial neoplasia precludes any definitive guidance or recommendations for clinical practice.

Vulvar intraepithelial neoplasia (VIN2/3): Comparing clinical outcomes and evaluating risk factors for recurrence

“…Similar to our findings, Herod et al (9) found, in a review of 114 women with VIN treated with surgical methods, a significantly higher rate of recurrence among those treated with laser ablation (75%) vs. local excision (40%). These findings are in contrast to most prior reports, including a Cochrane Review, which have not shown a difference in recurrence rates among the most commonly employed treatment modalities, surgical excision and laser ablation (4,6,8,10). There have been, however, differences with respect to recurrence among less commonly used techniques.…”

Management of Vaginal Discharge in Primary Care

“…37,38 Most studies and research relate to full thickness VIN. Multifocal lesions can be treated in the same manner as single lesions, but may have a higher recurrence rate.…”

Traitement des néoplasies vulvaires intra-épithéliales par imiquimod

“…Le traitement chirurgical des VIN a fait l'objet d'une revue publié e dans la Cochrane Database par Kaushik et al [11] en 2011. La problé matique du choix du type de thé rapeutique dans cette pathologie y est trè s bien rapporté e. Les auteurs rappellent que la population concerné e par les VIN est de plus en plus jeune, pré sente des lé sions souvent multiples et é tendues dé pendantes de l'HPV et que dans cette population l'exé rè se chirurgicale, anciennement traitement de ré fé rence, ne doit pas être systé matique en raison de la morbidité psychosexuelle.…”