High Grade Vaginal Intraepithelial Neoplasia

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 post-treatment 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. Post-treatment, if cytological abnormality develops in the presence of normal vaginoscopy, the majority of women will develop histological HG VaIN recurrence.

Abstract:To the Editor: Primary invasive carcinoma of the vagina is rare, accounting for less than 3 percent of malignant tumors of the female genital tract. Vaginal intraepithelial neoplasia, a precursor of invasive vaginal carcinoma, is even less common.1 Cytologic screening for vaginal tumors is not useful, unless there is a history of neoplasia of the lower genital tract.2,3 We treated three women with high-grade vaginal intraepithelial neoplasia by applying 5 percent imiquimod cream vaginally. Imiquimod induces the secretion of interferon-α, interleukin-12, and tumor necrosis factor α from mononuclear cells. All three women were positive for the high-risk type of . . .

Abstract:Objectives In a large retrospective study, the association of smoking with human papillomavirus (HPV) genotype and vaginal intraepithelial neoplasia (VAIN) grade was analyzed. Methods A SNOMED search was performed for vaginal biopsy or resection specimens diagnosed as VAIN over an 11-year period. The diagnosis of VAIN grade was confirmed by histological review. HPV genotype was determined by GP5+/6+ PCR and dot blot hybridization with type-specific oligonucleotide probes. Smoking history was obtained by chart review. Statistical analysis was performed using the chi-square test. Results We identified specimens from 111 patients (age range 15–84); 64% ( n =71) were diagnosed with high-grade VAIN (HGVAIN) and 36% ( n =40) with low-grade VAIN (LGVAIN). High-risk (HR) HPV genotypes were identified in 83% of specimens ( n =92), other types in 17% ( n =19). Twenty-one different HPV genotypes were detected in total. Smoking history was available for 81% ( n =90). Forty-one percent ( n =37) had a positive smoking history. There was no significant difference in infection with HR vs. other types ( p =0.92) among smokers when compared to non-smokers. In patients with HR HPV genotypes, smokers were at an increased risk for HGVAIN lesions when compared to patients who had never smoked (83% vs. 59%, p =0.02). Conclusions These data indicate an increased risk for HGVAIN in HR HPV positive women who smoke compared to HR HPV positive non-smokers.