Vaginal Intraepithelial Neoplasia: Clinical Presentation, Management, and Outcomes in Relation to HIV Infection Status

Bradbury, Melissa; Xercavins, Natalia; García-Jiménez, Ángel; Pérez-Benavente, Asunción; Franco-Camps, Sílvia; Cabrera, Sílvia; Sánchez-Iglesias, José Luís; Torre, Javier de la; Díaz-Feijoó, Berta; Centeno-Mediavilla, Cristina

doi:10.1097/lgt.0000000000000431

Cited by 14 publications

(20 citation statements)

References 24 publications

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“…We found that the distribution of age among different lesion grade groups (normal/benign, LSIL, HSIL and carcinoma) was significantly different, but the correlation between age and vaginal lesion grade was poor. These results were not identical to Zeligs' and Bradbury's reports, 26,28 possibly because of differences in sample selection and sample size.…”

Section: Discussioncontrasting

confidence: 71%

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

Zhou¹,

Zhang²,

Sui³

et al. 2020

CMAR

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To evaluate the colposcopic accuracy of the detection of vaginal intraepithelial neoplasia (VaIN) according to the colposcopic terminology for the vagina from the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC). Methods: A total of 467 women who were suspected of having VaIN and underwent colposcopy at Obstetrics and Gynecology Hospital of Fudan University from January to December 2018 were included in this retrospective cohort study. The 2011 IFCPC revised terminology for the vagina was applied, and the agreement between colposcopic diagnosis and vaginal biopsy pathology was analysed. Results: Agreement between colposcopy and pathology was 69.16% (kappa=0.437, p<0.001), with 23.34% overestimated and 7.49% underestimated diagnosis for colposcopy. The agreement was the lowest (35.71%) in the high-grade VaIN group, which was significantly different from that of other lesion grade groups (p<0.01). Among grade 1 findings, thin acetowhite epithelium was the most frequent (80.51%). Grade 2 findings and vascular patterns were rare. The positive predictive values of the micropapillary pattern were 55.98% for low-grade VaIN and 5.98% for high-grade VaIN. The specificity of iodine negativity was 10.92% for low-grade VaIN and 8.30% for high-grade VaIN. There were significant differences in the maximum size of single lesions and in the number of lesions among different grade lesion groups. Conclusion: The agreement between colposcopy findings utilizing the 2011 IFCPC terminology and vaginal pathology is moderate, and more definite findings for high-grade VaIN may be needed. The micropapillary pattern can be considered an alternative low-grade finding, while iodine staining is nonspecific for all lesions. Scattered and spotty lesions suggest low-grade VaIN, while large single lesions suggest high-grade VaIN.

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Section: Discussioncontrasting

confidence: 71%

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

Zhou¹,

Zhang²,

Sui³

et al. 2020

CMAR

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“… 54 In individuals living with HIV, VaIN presents at a median age of 39 years (vs 57 in HIV-negative), and is more frequently multifocal and multicentric. 136 The strong HPV field effect in the whole lower genital tract is confirmed. 25 , 129 , 137 …”

Section: Methodsmentioning

confidence: 78%

“…Rates of recurrence and progression of VaIN in HIV-positive and HIV-negative individuals are reported to be 44.8% and 3.4%, respectively, over a median of 68 months follow-up. No risk factors were identified for recurrence or progression, despite a trend in those who were HIV-positive 136 …”

Section: Methodsmentioning

confidence: 93%

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia

Kesić

Carcopino

Preti

et al. 2023

J Low Genit Tract Dis

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The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) developed consensus statements on pre-invasive vulvar lesions in order to improve the quality of care for patients with vaginal intraepithelial neoplasia (VaIN). The management of VaIN varies according to the grade of the lesion: VaIN 1 (low grade vaginal squamous intraepithelial lesions (SIL)) can be subjected to follow-up, while VaIN 2–3 (high-grade vaginal SIL) should be treated. Treatment needs individualization according to the patient’s characteristics, disease extension and previous therapeutic procedures. Surgical excision is the mainstay of treatment and should be performed if invasion cannot be excluded. Total vaginectomy is used only in highly selected cases of extensive and persistent disease. Carbon dioxide (CO 2 ) laser may be used as both an ablation method and an excisional one. Reported cure rates after laser excision and laser ablation are similar. Topical agents are useful for persistent, multifocal lesions or for patients who cannot undergo surgical treatment. Imiquimod was associated with the lowest recurrence rate, highest human papillomavirus (HPV) clearance, and can be considered the best topical approach. Trichloroacetic acid and 5-fluorouracil are historical options and should be discouraged. For VaIN after hysterectomy for cervical intraepithelial neoplasia (CIN) 3, laser vaporization and topical agents are not the best options, since they cannot reach epithelium buried in the vaginal scar. In these cases surgical options are preferable. Brachytherapy has a high overall success rate but due to late side effects should be reserved for poor surgical candidates, having multifocal disease, and with failed prior treatments. VaIN tends to recur and ensuring patient adherence to close follow-up visits is of the utmost importance. The first evaluation should be performed at 6 months with cytology and an HPV test during 2 years and annually thereafter. The implementation of vaccination against HPV infection is expected to contribute to the prevention of VaIN and thus cancer of the vagina. The effects of treatment can have an impact on quality of life and result in psychological and psychosexual issues which should be addressed. Patients with VaIN need clear and up-to-date information on a range of treatment options including risks and benefits, as well as the need for follow-up and the risk of recurrence.

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“…К факторам развития VAIN относят иммуносупрессию после трансплантации почки или других органов либо другие причины иммунодефицита, включая ВИЧ-инфекцию [6]. Установлено, что VАIN I диагностируется у 43-53% женщин, живущих с ВИЧ, а VAIN II-III -у 13-16% [22][23][24].…”

Section: классификация влагалищных интраэпителиальных неоплазийunclassified

“…В ретроспективном исследовании установлено, что частота прогрессии VAIN у пациенток после лучевой терапии, проведенной по поводу онкогинекологических заболеваний, была в 2 раза выше, чем у женщин, такую терапию не получавших [21]. Средний период от постановки диагноза ВИЧ до развития VAIN -14 лет [24].…”

Section: частота прогрессирования влагалищной интраэпителиальной неопunclassified

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

Zarochentseva¹,

Krasnopolsky²,

Dzhidzhikhiya³

et al. 2020

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Цель обзора: обобщение научных данных о диагностике, лечении, профилактике влагалищных интраэпителиальных неоплазий (vaginal intraepithelial neoplasia, VAIN). Основные положения. VAIN-редкое бессимптомное предраковое заболевание. Основные факторы риска возникновения VAINинфицирование вирусом папилломы человека (ВПЧ) и ранее проведенная гистерэктомия. При диагностике применяются цитологическое исследование, ВПЧ-тестирование, вагиноскопия и биопсия. В качестве методов лечения VAIN используются CO 2-лазер, петлевая электроэксцизия, кавитационная ультразвуковая хирургическая аспирация, лучевая терапия и др. Заключение. Нельзя недооценивать опасность поражения влагалища у ВПЧ-позитивных пациенток даже после проведенной гистерэктомии. Влагалище следует исследовать во время каждой кольпоскопии. Вакцинация против ВПЧ является действенной мерой профилактики ВПЧ-ассоциированных раков и предраков, включая VAIN. Ключевые слова: интраэпителиальная неоплазия влагалища, рак влагалища, клинические проявления, фотодинамическая терапия, вакцинация, вирус папилломы человека.

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Vaginal Intraepithelial Neoplasia: Clinical Presentation, Management, and Outcomes in Relation to HIV Infection Status

Cited by 14 publications

References 24 publications

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

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

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

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