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Wei J, Wu Y. Comprehensive evaluation of vaginal intraepithelial neoplasia development after hysterectomy: insights into diagnosis and treatment strategies. Arch Gynecol Obstet 2024:10.1007/s00404-024-07530-1. [PMID: 38743076 DOI: 10.1007/s00404-024-07530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Vaginal intraepithelial neoplasia (VaIN), a precancerous lesion associated with human papillomavirus (HPV), impacts women's health and quality of life. However, the natural progression of VaIN after hysterectomy remains uncertain, due to its low incidence. The existing literature predominantly consists of single-center retrospective studies lacking robust evidence-based medicine. The management of VaIN after hysterectomy is diverse and controversial, lacking a consensus on the optimal approach. Therefore, it is imperative to investigate the development of VaIN after hysterectomy, emphasizing the importance of accurate diagnosis and effective management strategies.
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Affiliation(s)
- Jiahui Wei
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yumei Wu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China.
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2
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Chen Y, Chen Q, Xue H, Zheng J, Chen J, Zheng X. Clinical Characteristics and Detection Sensitivity of Cervical Cancer Screening in Vaginal Intraepithelial Neoplasia. J Low Genit Tract Dis 2024; 28:137-142. [PMID: 38109483 DOI: 10.1097/lgt.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study aimed to investigate the characteristics and screening history of vaginal intraepithelial neoplasia (VaIN) or vaginal cancer and compare the sensitivity of cytology and human papillomavirus (HPV) tests on the cervix against vaginal and cervical high-grade squamous intraepithelial lesion or cancer. METHODS This study included patients who underwent colposcopy-directed biopsy and were diagnosed with VaIN or vaginal cancer from February 2013 to November 2022. Clinical information was obtained from the medical records of the department. Statistical analysis was performed on SPSS 26.0 (IBM Corp, Armonk, NY) using t test, chi-square, and Fisher exact tests. RESULTS A total of 1,166 patients were included in this study. The median age of VaIN2+ patients was 50.5 years, whereas VaIN1 reported a median age of 42.1 years old, p < .001. This study reported that VaIN was significantly and positively correlated with cervical lesions (r = 0.244). The high-risk HPV (hr-HPV) detection rate was 88.2% (858/973) in VaIN and 95.2% in VaIN2+. Human papillomavirus 16 was the most prevalent HPV type in VaIN2+, which accounted for 54.9%, followed by HPV58 (19.5%), HPV52 (15.2%), HPV51 (12.2%), and HPV18 (11.0%). The sensitivity of hr-HPV and cytology tests on the cervix for detecting VaIN2+ was 94.7% and 83.4%, respectively. Both tests were not significantly different from detecting cervical intraepithelial neoplasia 2+. CONCLUSIONS Human papillomavirus 16 is the dominant HPV type in vaginal precancer lesions. Cervical cancer screening has similar sensitivity for VaIN2+ as for cervical intraepithelial neoplasia 2+, with hr-HPV testing showing higher sensitivity than cytology.
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Affiliation(s)
- Yusha Chen
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiaoyun Chen
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Huifeng Xue
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jinwen Zheng
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jiancui Chen
- Cervical Disease Diagnosis and Treatment Health Center, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiangqin Zheng
- Department of Gynecology, Fujian Maternity and Child Health Hospital College of Clinical Medical for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Wang B, Zhang C, Su Y, Yuan S, Zhou M, Zhang M, Zhou Y, Cao L, Zhang M, Zhang T. Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery in treating vaginal high-grade squamous intraepithelial lesions following hysterectomy. Photodiagnosis Photodyn Ther 2024; 45:103921. [PMID: 38097122 DOI: 10.1016/j.pdpdt.2023.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating vaginal high-grade squamous intraepithelial lesions (HSIL) after hysterectomy due to cervical cancer (CC) or precancerous lesions. METHODS A retrospective study was performed comprising 41 women with histologically confirmed vaginal HSIL after hysterectomy for CC or cervical HSIL. Patients were treated with surgery or ALA-PDT and were followed up at 3, 6 and 12 months and then every six months afterwards. Clinical data were collected and the efficacy and safety of the two groups were analyzed. RESULTS Of the 41 patients with vaginal HSIL after hysterectomy, 18 were treated with ALA-PDT and 23 underwent surgery. There was no significant difference in the lesions' complete remission (CR) rate or the human papillomavirus (HPV) clearance rate between the ALA-PDT group and the surgery group (P > 0.05). In the surgery group, the clearance rate of HPV16/18 was higher than that of other high-risk HPV (HR-HPV) and HPV16/18 combined with other HR-HPV (87.50 % vs. 45.45 % vs. 0.00 %, P = 0.014). No significant difference in the recurrence rate between the two groups was noted (P > 0.05). And none of the patients progressed. In the surgery group, one patient developed significant thickening of the vaginal stump, and one patient had increased vaginal discharge. In women treated with ALA-PDT, there was no vaginal bleeding or harmful effects on the organizational structure or functions compared to the surgery group. CONCLUSIONS The efficacy of ALA-PDT was comparable to that of surgery in treating vaginal HSIL following hysterectomy due to CC or cervical HSIL, with fewer side effects.
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Affiliation(s)
- Bingjie Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Su
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyu Yuan
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjiao Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhuo Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhen Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Ting Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Liu Y, Mao M, Bai J, Cai M, Wang Q, Fu H, Zhao M, Wang C, Si L, Guo R. Is robotic-assisted vaginectomy a better choice in vaginal high-grade squamous intraepithelial lesions than conventional laparoscopic surgery? BMC Womens Health 2024; 24:36. [PMID: 38218831 PMCID: PMC10788024 DOI: 10.1186/s12905-024-02882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Vaginectomy has been shown to be effective for select patients with vaginal high-grade squamous intraepithelial lesions (HSIL) and is favored by gynecologists, while there are few reports on the robotic-assisted laparoscopic vaginectomy (RALV). The aim of this study was to evaluate the safety and treatment outcomes between RALV and the conventional laparoscopic vaginectomy (CLV) for patients with vaginal HSIL. METHODS This retrospective cohort study was conducted in 109 patients with vaginal HSIL who underwent either RALV (RALV group) or CLV (CLV group) from December 2013 to May 2022. The operative data, homogeneous HPV infection regression rate and vaginal HSIL regression rate were compared between the two groups. Student's t-test, the Mann-Whitney U test, Pearson χ2 test or the Fisher exact test, Kaplan-Meier survival analysis and Cox proportional-hazards models were used for data analysis. RESULTS There were 32 patients in the RALV group and 77 patients in the CLV group. Compared with the CLV group, patients in the RALV group demonstrated less estimated blood loss (41.6 ± 40.3 mL vs. 68.1 ± 56.4 mL, P = 0.017), lower intraoperative complications rate (6.3% vs. 24.7%, P = 0.026), and shorter flatus passing time (2.0 (1.0-2.0) vs. 2.0 (2.0-2.0), P < 0.001), postoperative catheterization time (2.0 (2.0-3.0) vs. 4.0 (2.0-6.0), P = 0.001) and postoperative hospitalization time (4.0 (4.0-5.0) vs. 5.0 (4.0-6.0), P = 0.020). In addition, the treatment outcomes showed that both RALV group and CLV group had high homogeneous HPV infection regression rate (90.0% vs. 92.0%, P > 0.999) and vaginal HSIL regression rate (96.7% vs. 94.7%, P = 0.805) after vaginectomy. However, the RALV group had significantly higher hospital costs than that in the CLV group (53035.1 ± 9539.0 yuan vs. 32706.8 ± 6659.2 yuan, P < 0.001). CONCLUSIONS Both RALV and CLV can achieve satisfactory treatment outcomes, while RALV has the advantages of less intraoperative blood loss, fewer intraoperative complications rate and faster postoperative recovery. Robotic-assisted surgery has the potential to become a better choice for vaginectomy in patients with vaginal HSIL without regard to the burden of hospital costs.
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Affiliation(s)
- Yana Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Meng Mao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Jing Bai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Mingbo Cai
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Qian Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Hanlin Fu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Mengling Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Chunfang Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Lulu Si
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China
| | - Ruixia Guo
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe East Road, Zhengzhou City, 450052, Henan, China.
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Tanaka M, Yamanoi K, Taki M, Kitamura S, Sunada M, Chigusa Y, Horie A, Yamaguchi K, Hamanishi J, Mandai M. High-grade vaginal intraepithelial neoplasia after hysterectomy for high-grade cervical intraepithelial neoplasia: Is hysterectomy a "definitive" treatment compared to conization? J Obstet Gynaecol Res 2023; 49:2361-2369. [PMID: 37354106 DOI: 10.1111/jog.15723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023]
Abstract
AIM We investigated the frequency of early recurrence of vaginal intraepithelial neoplasia grade 2/3 (VaIN 2/3) (within 2 years) after hysterectomy for cervical intraepithelial neoplasia grade 3 (CIN3). The characteristics of the clinicopathological factors common to them were explored including different surgical methods. METHODS As a retrospective observational study, a total of 647 CIN3 patients were divided into a conization and hysterectomy group (C group, n = 492; H group, n = 155), and HSIL (CIN2/3 or VaIN2/3) recurrence within 2 years after surgery was evaluated. A stratified analyses was performed. Surgical methods were divided into trans-abdominal, trans-vaginal, and laparoscopic. RESULTS The recurrence of VaIN3 was detected in four cases (2.6%) in the H group, which was similar to that of CIN2/3 in the C group, 12 out of 491 patients (2.4%). The patients who developed VaIN3 were significantly older than those who did not (median, VaIN3: 71.0; VaIN1 and less: 48.0; p < 0.0001). All VaIN3 cases were detected within 5 months, although majority of cases were negative in the margin (3/4 cases; margin negative). The method of hysterectomy was not related to the VaIN3 recurrence. CONCLUSION For CIN3 patients for whom hysterectomy is the main treatment, VaIN3 can develop in 2.6% within very shortly after operation even if surgical margin was negative. The elder the age, the higher the risk of early recurrence could be. Laparoscopic surgery is considered to be acceptable methods of hysterectomy.
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Affiliation(s)
- Miyu Tanaka
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Yamanoi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mana Taki
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Kitamura
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masumi Sunada
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshitsugu Chigusa
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihito Horie
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Lei S, Wu C, Zhong S, Liu Y, Peng K, Han X, Chen J, Li C, Gao S. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO 2 laser ablation: A retrospective study. Open Life Sci 2023; 18:20220621. [PMID: 37589004 PMCID: PMC10426724 DOI: 10.1515/biol-2022-0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/08/2023] [Accepted: 04/27/2023] [Indexed: 08/18/2023] Open
Abstract
This study aims to investigate the influence of topical estrogen management in postmenopausal patients who had undergone CO2 laser ablation for vaginal squamous intraepithelial lesions (SILs). The clinical data of 211 postmenopausal women with vaginal SILs were reviewed. Patients were divided into two groups by 2-month different management: Group 1 (intervention group): patients were treated with estrogen cream 0.5 g every other day and Group 2 (control group): no topical agent was used for the treatment of patients. In low-grade squamous intraepithelial lesions (LSILs), the response rates for patients in the intervention group and the control group were 49.1% (27/55) and 54.2% (16/48), respectively; human papillomavirus (HPV) status turned negative in 12 (12/38, 31.6%) patients of the intervention group and in 15 (15/35, 42.9%) patients of the control group. In high-grade squamous intraepithelial lesions (HSILs), the response rates for patients in the intervention group and the control group were 72.4% (42/58) and 78.0% (39/50), respectively, nearly 1.5 times higher than those of the LSIL patients; 22 (22/54, 40.7%) patients of the intervention groups and 12 (12/46, 26.1%) patients of the control group cleared the HPV infection. In postmenopausal patients, local use of estrogen cream improves the recognition of lesions and is conducive to precision medicine.
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Affiliation(s)
- Shengyao Lei
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Congquan Wu
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Siyi Zhong
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Yanmei Liu
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Ke Peng
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai200011, China
| | - Xiao Han
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Jialing Chen
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
| | - Chunlan Li
- Department of Gynecology, Children’s Hospital of Anhui Province, No. 39 East Wangjiang Road, Hefei230022, China
| | - Shujun Gao
- Department of Gynecology, Center of Diagnosis and Treatment for Cervical & Uterine Cavity Diseases, Obstetrics and Gynecology Hospital of Fudan University, No. 419 Fangxie Road, Huangpu District, Shanghai200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Disease, Fudan University, Shanghai200011, China
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Kurihara S, Hamasaki Y, Onjo S, Nishiyama K, Nishida M. Hysterectomy through Minimally Invasive Surgery for Cervical High-grade Intraepithelial Neoplasia: Reassessment of the Specimens' Eligibility for Histological Examination. Gynecol Minim Invasive Ther 2023; 12:148-152. [PMID: 37807995 PMCID: PMC10553598 DOI: 10.4103/gmit.gmit_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives The objective was to investigate the microscopic artifacts made in the uterus of cervical high-grade squamous intraepithelial lesion (HSIL) resected by hysterectomy through minimally invasive (H-MI) procedures and to verify whether these specimens are suitable for histopathological assessment. Materials and Methods This single-center retrospective study analyzed 28 patients with cervical HSIL, consisting of 21 premenopausal and seven postmenopausal women, who underwent H-MI. The proportion of the cervical mucosa covered by intact surface epithelium (residual ratio [RR]) was measured on microscopically. Surgical margin's status was also verified. Results All cases developed detachment of the cervical surface epithelium to a varying extent. The RR was significantly higher in the premenopausal patients (median: 75.5%) than in the postmenopausal patients (median: 37.6%). Among the premenopausal patients, the RR was lower in the cases on whom uterine manipulator (UM) was used (median: 70.5%) than in the cases without UM use (median 92.7%). Among the 21 cases whose resected uterus contained HSIL, the vaginal resection margin was not assessable in three (14.2%) of the seven postmenopausal cases due to the artifact. Conclusion Although transvaginal manipulation of the uterus causes detachment of the cervical surface epithelium, H-MI for cervical HSIL provides an acceptable specimen for histological assessment in premenopausal patients, even if UM is used. In postmenopausal women, H-MI easily develops artifactual loss of cervical surface epithelium, sometimes providing an unfavorable specimen for microscopic assessment.
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Affiliation(s)
- Shuichi Kurihara
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
- Department of Obstetrics and Gynecology, Japanese Red Cross Matsuyama Hospital, Matsuyama, Ehime, Japan
| | - Yoichiro Hamasaki
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Sachiko Onjo
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Kenichi Nishiyama
- Department of Pathology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
| | - Makoto Nishida
- Department of Obstetrics and Gynecology, Japanese Red Cross Fukuoka Hospital, Ogusu, Minami-Ku, Fukuoka, Japan
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Zigras T, Mayrand MH, Bouchard C, Salvador S, Eiriksson L, Almadin C, Kean S, Dean E, Malhotra U, Todd N, Fontaine D, Bentley J. Canadian Guideline on the Management of a Positive Human Papillomavirus Test and Guidance for Specific Populations. Curr Oncol 2023; 30:5652-5679. [PMID: 37366908 DOI: 10.3390/curroncol30060425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
The purpose of this paper is to provide evidence-based guidance on the management of a positive human papilloma virus (HPV) test and to provide guidance around screening and HPV testing for specific patient populations. The guideline was developed by a working group in collaboration with the Gynecologic Oncology Society of Canada (GOC), Society of Colposcopists of Canada (SCC), and the Canadian Partnership Against Cancer. The literature informing these guidelines was obtained through a systematic review of relevant literature by a multi-step search process led by an information specialist. The literature was reviewed up to July 2021 with manual searches of relevant national guidelines and more recent publications. The quality of the evidence and strength of recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The intended users of this guideline include primary care providers, gynecologists, colposcopists, screening programs, and healthcare facilities. The implementation of the recommendations will ensure an optimum implementation of HPV testing with a focus on the management of positive results. Recommendations for appropriate care for underserved and marginalized groups are made.
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Affiliation(s)
- Tiffany Zigras
- Trillium Health Partners, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada
| | - Marie-Hélène Mayrand
- Département d'obstétrique-gynécologie, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Celine Bouchard
- Clinique de Researche en Sante des femmes, Quebec City, QC G1V 3M7, Canada
| | - Shannon Salvador
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Lua Eiriksson
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Chelsea Almadin
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC H3Z 2H5, Canada
| | - Sarah Kean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Erin Dean
- Department of Obstetrics, Gynecology and Reproductive Sciences, Winnipeg, MB R3J 3T7, Canada
| | - Unjali Malhotra
- Office of the Chief Medical Officer, First Nations Health Authority, West Vancouver, BC V7T 1A2, Canada
| | - Nicole Todd
- Department of Obstetrics and Gynecology UBC, Vancouver, BC V5Z 4E1, Canada
| | - Daniel Fontaine
- Department of Pathology and Laboratory Medicine, Valley Regional Hospital, Kentville, NS B4N 5E3, Canada
| | - James Bentley
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS B3H 4R2, Canada
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9
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Kesic V, Carcopino X, Preti M, Vieira-Baptista P, Bevilacqua F, Bornstein J, Chargari C, Cruickshank M, Erzeneoglu E, Gallio N, Gultekin M, Heller D, Joura E, Kyrgiou M, Madić T, Planchamp F, Regauer S, Reich O, Esat Temiz B, Woelber L, Zodzika J, Stockdale C. 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. Int J Gynecol Cancer 2023; 33:446-461. [PMID: 36958755 PMCID: PMC10086489 DOI: 10.1136/ijgc-2022-004213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
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 (CO2) 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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Affiliation(s)
- Vesna Kesic
- Medical Faculty, University of Belgrade, Clinic of Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mario Preti
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Pedro Vieira-Baptista
- Lower Genital Tract Unit Centro Hospitalar de São João, Porto, Portugal
- Hospital Lusiadas, Porto, Portugal
| | | | - Jacob Bornstein
- Galilee Medical Center and Azrieli Faculty of Medicine, Bar-Ilan, Israel
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Maggie Cruickshank
- Aberdeen Centre for Women's Health Research, University of Aberdeen, Aberdeen, UK
| | - Emre Erzeneoglu
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Niccolò Gallio
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Murat Gultekin
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Debra Heller
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Elmar Joura
- Department of Gynecology and Gynecologic Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maria Kyrgiou
- Surgery and Cancer - West London Gynecological Cancer Center, IRDB, Department of Gut, Metabolism & Reproduction-Surgery & Cancer, Imperial College London, London, UK
- Imperial Healthcare NHS Trust, Queen Charlotte's & Chelsea Hospital West London Gynaecological Cancer Centre, London, UK
| | - Tatjana Madić
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Sigrid Regauer
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Olaf Reich
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Bilal Esat Temiz
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecological Oncology, Hacettepe University, Ankara, Turkey
| | - Linn Woelber
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany
- Dysplasia Center Hamburg; Jerusalem Hospital Hamburg, Hamburg, Germany
| | - Jana Zodzika
- Department of Obstetrics and Gynaecology Rīga Stradiņš University, Riga, Latvia
| | - Colleen Stockdale
- Department of Obstetrics & Gynecology, University of Iowa, Iowa City, Iowa, USA
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10
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Zhao X, Song S, Wang Y, Mu X, Zhang L. Effects of photodynamic therapy in the treatment of high-grade vaginal intraepithelial lesions following hysterectomy and HPV infection. Photodiagnosis Photodyn Ther 2023; 42:103336. [PMID: 36773752 DOI: 10.1016/j.pdpdt.2023.103336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/20/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Non-invasive treatment therapy, such as 5-Aminolevulinic acid photodynamic therapy (ALA-PDT), has gained attention for its effect on select cervical and vaginal lesions. To investigate the effect of ALA-PDT on high-grade vaginal intraepithelial lesions (HG VAIN) after hysterectomy and high-risk human papillomavirus (HR-HPV) infection, in this study, we evaluated the clinical efficacy and safety of ALA-PDT in 23 patients with HG VAIN following hysterectomy and HPV. METHODS 23 patients with HG VAIN after hysterectomy were selected for photodynamic therapy, and the therapeutic effect, adverse reactions, recurrence rate and HPV clearance rate were analyzed respectively. The patients were followed up at 3, 6, 9, and 12 months after ALA-PDT. HPV, thinprep cytologic test (TCT) and reid colposcopic index (RCI) score should be performed 3 months after treatment. When the RCI score is higher than or equal to 3, a colposcopy biopsy should be conducted, the additional ALA-PDT should be continued if residual lesions were detected. When the RCI score is lower than or equal to 2, HPV and TCT should be reviewed every 3 months. RESULTS After 3 months of photodynamic therapy, 21 patients were cured, with the cure rate of 91.3% (21/23). Two patients (8.7%) had residual lesions, which had degraded compared with the previous. After treatment, the overall HR-HPV clearance rate was 56.5% at 3 months, 65.2% at 6 months, 69.5% at 9 months, and 74% at 12 months. No obvious adverse reactions were found during and after treatment. Moreover, no recurrence occurred during the whole follow-up period. CONCLUSIONS Compared with other therapies, ALA-PDT is a novel therapy with non-invasive procedure in HG VAIN after hysterectomy. ALA-PDT can be used for the treatment of HG VAIN after hysterectomy, moreover, it can not only effectively clear HR-HPV, but also can prevent the recurrence and progression of vaginal lesions caused by persistent HR-HPV infection.
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Affiliation(s)
- Xiaofeng Zhao
- Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shufang Song
- Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
| | - Yu Wang
- Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiaojie Mu
- Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lili Zhang
- Department of Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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11
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Which Risk Factors and Colposcopic Patterns Are Predictive for High-Grade VAIN? A Retrospective Analysis. Diagnostics (Basel) 2023; 13:diagnostics13020176. [PMID: 36672986 PMCID: PMC9858341 DOI: 10.3390/diagnostics13020176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Colposcopic patterns of Vaginal Intraepithelial Neoplasia (VAIN) are not definitively related to histological grade. The aim of the present study was to investigate any correlation between clinical and colposcopic features and the development of high-grade VAIN. Two hundred and fifty-five women diagnosed with VAIN (52 VAIN1, 55 VAIN2 and 148 VAIN3) at the European Institute of Oncology, Milan, Italy, from January 2000 to June 2022, were selected for a retrospective analysis. Multivariate logistic regression was performed to estimate the association of risk factors and colposcopic patterns with VAIN grade. Smoking was associated with the development of VAIN (34.1%, p = 0.01). Most women diagnosed with VAIN3 (45.3%, p = 0.02) had a previous history of hysterectomy for CIN2+. At multivariate analysis, colposcopic grade G2 (OR = 20.4, 95%CI: 6.67−61.4, p < 0.001), papillary lesion (OR = 4.33, 95%CI: 1.79−10.5, p = 0.001) and vascularity (OR = 14.4, 95%CI: 1.86−112, p = 0.01) were significantly associated with a greater risk of VAIN3. The risk of high-grade VAIN should not be underestimated in women with a history of smoking and previous hysterectomy for CIN2+, especially when colposcopic findings reveal vaginal lesions characterized by grade 2, papillary and vascular patterns. Accurate diagnosis is crucial for an optimal personalized management, based on risk factors, colposcopic patterns and histologic grade of VAIN.
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12
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Monti E, Libutti G, Di Loreto E, Boero V, Barbara G, Iorio M, Cetera GE, Cipriani S, Parazzini F. High-grade vaginal intraepithelial neoplasia and recurrence risk: analysis of an Italian regional referral center series. Arch Gynecol Obstet 2022; 308:201-206. [PMID: 36564638 DOI: 10.1007/s00404-022-06886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE The main aim of this study was to investigate the long-term risk of disease recurrence in women treated for high-grade vaginal intraepithelial neoplasia (HG-VaIN). METHODS We conducted a retrospective analysis on a cohort of 82 women diagnosed with HG-VaIN between 2010 and 2021 at the "Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders", Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. All women underwent either ablative treatment (CO2 laser ablation or electrocoagulation) or cold-knife excision. RESULTS In our series, the recurrence rate following treatment was 17%. The 5-year cumulative probability of recurrence was 30.4% and the median time to recurrence was 15.5 months. None of the patients progressed to invasive vaginal cancer during follow-up. A concomitant cervical or vulvar intraepithelial lesion was significatively associated with an increased risk of recurrence (p = 0.006). CONCLUSIONS The results of our study suggest that women with HG-VaIN are at high risk of developing disease recurrence after treatment, especially patients with a concomitant cervical or vulvar intraepithelial lesion. In these women strict monitoring is mandatory to obtain an early identification of recurrence.
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Affiliation(s)
- Ermelinda Monti
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Giada Libutti
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Veronica Boero
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Giussy Barbara
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maria Iorio
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy
| | - Giulia Emily Cetera
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda-Ospedale Maggiore Policlinico, Via Commenda, 12, 20122, Milan, Italy.
| | - Sonia Cipriani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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13
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Huang J, Wei Y, Gu L, Di W, Hong Z, Qiu L. Feasibility study of 5-aminolevulinic acid mediated photodynamic therapy of persistent vaginal high-risk HPV infection of post-hysterectomy patients. Photodiagnosis Photodyn Ther 2022; 41:103250. [PMID: 36565730 DOI: 10.1016/j.pdpdt.2022.103250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients after hysterectomy are at higher risk for developing VaIN. However, there are no standard treatments for HPV infection and VaIN after hysterectomy and relative studies are limited. Thus we aim to evaluate the feasibility of 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) for the treatment of persistent vaginal infection with high-risk HPV (HR-HPV) in post-hysterectomy patients. METHODS Thirty-eight patients aged 43-70 years old with persistent vaginal stump HR-HPV infection with or without histological vaginal intraepithelial neoplasia (VaIN1) during follow-up after hysterectomy were recruited. Twenty patients received three times of ALA-PDT (PDT Group). Eighteen patients did not receive any treatments (Control Group). HPV testing, cytology, and colposcopy were performed in all patients 4-6 months and 12 months after treatment. RESULTS HR-HPV remission rates of the PDT Group were 40% (8/20) and 66.67% (12/18) at the 4-6 month and 12-month follow-up, respectively, both were significantly higher than that of the Control Group (11.11% (2/18) and 6.23% (1/16), respectively; P < 0.05). For the PDT Group, the regression rate of VaIN1 was 100% (7/7) at 4-6 months, while VaIN1 recurred in two cases (28.6%) at the 12-month due to persistent HR-HPV infection. No persistence or progression of VaIN1 was noted. For the Control group, the spontaneous regression rate of VaIN1 was 50% (3/6) at 4-6 months and one patient progressed into VaIN2. At the 12-month follow-up point, one patient reccurred and the disease regression, persistence and recurrence rates were 40% (2/5), 40% (2/5) and 20% (1/5), respectively. Adverse reactions were mild after PDT treatment. CONCLUSION 5-ALA-PDT is a safe, non-invasive, and effective option for post-hysterectomy patients who have persistent HR-HPV infection.
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Affiliation(s)
- Jinhua Huang
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingting Wei
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liying Gu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Di
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Gynecologic Oncology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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14
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Mbuyisa SS, Khumalo TL, Makhathini BS, Moodley J. Prevalance of abnormal vault cytology after hysterectomy for cervical intraepithelial neoplasia, Pietermaritzburg. S Afr Fam Pract (2004) 2022; 64:e1-e5. [PMID: 35384680 PMCID: PMC8991234 DOI: 10.4102/safp.v64i1.5457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A simple hysterectomy is considered the definitive treatment modality for cervical intraepithelial neoplasia (CIN). However, it is associated with recurrence of vaginal intraepithelial neoplasia (VAIN) of up to 7.4%. We sought to determine recurrence rates of VAIN, in women living with HIV (WLWH) and non-infected women. METHODS This was a descriptive retrospective review of patients who received a simple hysterectomy for CIN between January 2015 and December 2017 in Pietermaritzburg. RESULTS Fifty-eight files were reviewed. Forty-two (72.4%) WLWH were seen; amongst those, 76.2% were virally suppressed. Abnormal vault cytology was only seen in patients with CIN grades 2 and 3. The recurrence rates for high-grade squamous intraepithelial lesion (HSIL) were 6.1% and 5.0% at 6 and 12 months, respectively. Human immunodeficiency virus co-infection was associated with 26.2% versus 13.3% of abnormal vault cytology compared to the HIV-negative counterparts (p = 0.164). Virologically suppressed patients had more abnormal cytology (28.1% vs. 0%) compared to the unsuppressed patients. There was a 17.2% and 65.5% loss- to follow-up rates at 6 and 12 months, respectively. Recurrence of premalignant lesions was noted amongst those who had the abdominal approach. CONCLUSION The recurrence rates were comparable to the previous literature. A 6-month cytology follow-up showed no added benefit. Human immunodeficiency virus co-infection didn't show a statistical significance on the recurrence rates; however, more structured studies are required to address this. Primary health care-based post operative surveillance can be a solution to address high loss to follow-up.
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Affiliation(s)
- Sanele S Mbuyisa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg.
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15
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Lee F, Desravines N, Recknagel J, Singleton M, Muñoz R, Rahangdale L. History of Surgical Treatment for Cervical Intraepithelial Neoplasia. J Gynecol Surg 2022. [DOI: 10.1089/gyn.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Fan Lee
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nerlyne Desravines
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Johnathon Recknagel
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Miller Singleton
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rodrigo Muñoz
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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16
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Ao M, Zheng D, Wang J, Gu X, Xi M. Risk factors analysis of persistence, progression and recurrence in vaginal intraepithelial neoplasia. Gynecol Oncol 2021; 162:584-589. [PMID: 34226020 DOI: 10.1016/j.ygyno.2021.06.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to profile patients with vaginal intraepithelial neoplasia (VAIN), to evaluate natural history and to identify risk factors for persistence, progression and recurrence. METHODS At West China Second University Hospital, all patients with histologically confirmed VAIN over a five-year period with minimum follow-up of 6 months were retrospectively identified. Demographics, medical history and clinical information related to the diagnosis and treatment were extracted. Clinical outcomes included normalization, persistence, progression and recurrence. We evaluated risk factors by univariate and multivariate analyses. RESULTS A total of 1478 patients fulfilled the inclusion criteria with a median follow-up of 14 months (range, 6-60 months). In 86.6% of patients, VAIN went into normalization, 6.4% persisted, 3.5% progressed and 3.5% recurred. Besides, 24 (7.1%) VAIN 3 patients and 4 (0.8%) progressed to cancer, accounting for 85.7% and 14.3% of cancer cases, respectively. VAIN 3 patients treated with excision yielded superior outcomes. Risk factors for persistence were HPV 16, 56, 59 and 43 infections, for progression were prior hysterectomy for cervical lesions and HPV 56 infection, for recurrence were HPV 61 infection. CONCLUSION Although VAIN will regress in most patients, there are still risks of persistence, recurrence and progression, even malignancy. Therefore, a long-term follow-up is recommended. Patients with VAIN 3 are at higher risk of progressing to cancer and excision is preferred. HPV 16, 56, 59 and 43 infections might associate with an increased risk of persistence and patients with prior hysterectomy for cervical lesions tend to progress.
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Affiliation(s)
- Mengyin Ao
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu 61 0000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| | - Danxi Zheng
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu 61 0000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| | - Jingwen Wang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu 61 0000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
| | - Xuesai Gu
- Department of Information Management, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu 61 0000, China
| | - Mingrong Xi
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Number 20, Third Section of People's South Road, Chengdu 61 0000, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China.
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17
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Yamamoto K, Kitai M, Yamamoto K, Sakuma T, Nagao S, Yamaguchi S. Successful Endoscopic Treatment for High-grade Cervical Intraepithelial Neoplasia with Gross Lesions of the Vagina. Gynecol Minim Invasive Ther 2021; 10:124-126. [PMID: 34040974 PMCID: PMC8140545 DOI: 10.4103/gmit.gmit_119_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/14/2020] [Accepted: 03/11/2020] [Indexed: 11/26/2022] Open
Abstract
We present a patient diagnosed with high-grade cervical intraepithelial neoplasia (CIN) combined with macroscopic lesions of the vaginal epithelium. There was no lesion in pelvic magnetic resonance imaging examination, and histopathological examination revealed CIN3 and vaginal intraepithelial neoplasia (VAIN) 3 without invasion. We chose minimally invasive surgery for her and total laparoscopic hysterectomy with partial resection of the vagina was carried out. To determine appropriate surgical margins, vaginal colpotomy was performed. No recurrence of VAIN has been observed to date that passed for 9 months either.
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Affiliation(s)
- Koyo Yamamoto
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Miho Kitai
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Kasumi Yamamoto
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Toshiko Sakuma
- Department of Pathology, Hyogo Cancer Center, Hyogo, Japan
| | - Shoji Nagao
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Satoshi Yamaguchi
- Department of Gynecologic Oncology, Hyogo Cancer Center, Hyogo, Japan
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18
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Yu D, Qu P, Liu M. Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients. J Obstet Gynaecol Res 2021; 47:1624-1630. [PMID: 33754436 DOI: 10.1111/jog.14733] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/28/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
The incidence of vaginal intraepithelial neoplasia (VAIN) is increasing annually; however, the reported values are likely underestimated. Risk factors for VAIN include advanced age, human papillomavirus (HPV) infection, history of hysterectomy, and simultaneous or previous cervical intraepithelial neoplasia (CIN) or cervical cancer cervical cancer. The most common presentation is abnormal cytology without clinical symptoms. Despite various treatment modalities available, the rate of disease recurrence is high, and its malignant potential has been documented. This study aimed to examine demographic and clinical characteristics and associated treatment outcomes of patients with VAIN. We retrospectively reviewed clinicopathologic data and clinical outcomes of patients diagnosed with VAIN at a single center between January 2010 and December 2017. Overall, 118 patients were included (average age 49.81 ± 9.77 years; range, 26-70 years). The distribution of the histologic grade was as follows: VAIN1, 30.5%; VAIN2, 41.5%; and VAIN3, 28.0%. In total, 97 (82.2%) patients had either prior or simultaneous cervical lesions, CIN (35.6%), or cervical cancer (55, 46.6%). A total of 100 cases (84.7%) were diagnosed using colposcopy and 18 (15.3%) were diagnosed by pathological accident after hysterectomy. Thin-prep cytology test (TCT) results were available for 112 (94.9%) patients, and 111 (94.1%) patients had abnormal cytology findings. Most patients were confirmed as HPV positive (115, 97.5%), and 84 (71.2%) patients were confirmed as positive for high-risk HPV types. Forty-two (35.6%) patients underwent hysterectomy before VAIN diagnosis, and the median interval between hysterectomy and VAIN diagnosis was 26.5 (range: 3-68) months. Most surgical indications were HPV-related diseases (34, 80.9%), such as CIN (8, 19.0%) or cervical cancer (26, 61.9%). Eight patients had no history of cervical lesions. A total of 100 patients underwent initial treatment. During the median follow-up period of 29 (range: 9-96) months, 78 (78%) patients experienced disease remission after initial treatment, 7 (7%) experienced disease recurrence, 10 (10%) had persistent disease, and 5 (5%) had progressive disease. Finally, two patients developed vaginal cancer without death. Colposcopy should be performed before vaginal hysterectomy for VAIN, particularly HPV-related cases. The incidence of VAIN was 20% after hysterectomy owing to non-HPV-related lesions; thus, this part of the screening should not be discontinued. VAIN grade 2,3 and VAIN associated with CIN or cervical cancer are disease types more likely to recur and progress to invasive cancer; active medical intervention is recommended.
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Affiliation(s)
- Dake Yu
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Pengpeng Qu
- Department of Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China
| | - Meihua Liu
- Department of Obstetrics & Gynecology, Tianjin Medical University, Tianjin, China
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Cao D, Wu D, Xu Y. Vaginal intraepithelial neoplasia in patients after total hysterectomy. Curr Probl Cancer 2020; 45:100687. [PMID: 33309077 DOI: 10.1016/j.currproblcancer.2020.100687] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the incidence of vaginal intraepithelial neoplasia (VaIN) after total hysterectomy and, subsequently, optimize the follow-up strategy of patients after hysterectomy. METHODS This retrospective study was conducted on 8581 patients with benign gynecology disease who underwent total hysterectomy in our institution between January 2006 to December 2017, including 834 patients with cervical intraepithelial neoplasia (CIN) and 7747 patients without cervical lesions before hysterectomy. All patients underwent postoperative high-risk human papilloma virus (Hr-HPV) screening and liquid-based cytology test (LCT) as confirmatory tests. Colposcopies were performed if the results of the confirmatory tests were abnormal, and biopsies were performed depending on colposcopy images. The mean follow-up time was 33.8 ± 12.1 months. The relationship among VaIN, CIN, and confirmatory test results was investigated. RESULTS VaIN was found in 81 patients after hysterectomy (incidence rate, 0.9%). The incidence rates of VaIN in patients with and without CIN history were significantly different (7.3%, 61/834, vs 0.3%, 20/7747; P < 0.05). Compared with patients without CIN history, those with CIN history were more likely to have abnormal LCT results in the postoperative follow-up, especially low-grade squamous intraepithelial lesions or worse (P < 0.001). Patients with high-grade squamous intraepithelial lesions in the LCT have a high VaIN incidence (patients with CIN history, 57.1%; patients without CIN history, 15.1%), and the 2 patients with squamous cell carcinoma or adenocarcinoma (SCC/AC) in the LCT had CIN and VaIN or worse after hysterectomy. The Hr-HPV infection rates after the hysterectomy of patients with and without CIN history were 18.8% (157/834) and 5.4% (419/7747), respectively. The incidences morbidities of VaIN in patients with persistent Hr-HPV infection and in those with and without CIN history were 35.7% and 12.0%, respectively, and were significantly higher than those in patients with negative Hr-HPV (patients with CIN history, 0.7%; patients without CIN history, 0.1%; P = 0.002). The incidence of VaIN in patients with CIN history with HPV-16 infection after hysterectomy was as high as 50%, but in patients without CIN history, the incidences of different Hr-HPV subtypes were not significantly different (P = 0.953). CONCLUSION Patients with CIN history were more prone to VaIN and SCC after hysterectomy than were patients without CIN history. Patients should be screened thoroughly for cervical and vaginal lesions before hysterectomy. After hysterectomy, patients with CIN history should undergo lifetime annual LCT and HPV screening.
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Affiliation(s)
- Dan Cao
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Wu
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Xu
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Imiquimod for vaginal intraepithelial neoplasia 2-3: A systematic review and meta-analysis. Gynecol Oncol 2020; 160:140-147. [PMID: 33010966 DOI: 10.1016/j.ygyno.2020.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The treatment strategy for vaginal intraepithelial neoplasia (VaIN) 2-3 has not been established. This study aimed to investigate the efficacy of imiquimod in VaIN 2-3. METHODS Electronic databases (PubMed, EMBASE, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials) were searched from their inception until October 2019 and articles reporting imiquimod treatment for VaIN 2-3 were extracted. Additionally, the clinical records of women with VaIN 2-3 who had been treated with imiquimod in Shizuoka General Hospital from January 2016 to May 2020 were investigated. The data from the systematic search and the data from our hospital were analyzed, and a pooled complete response (CR) rate and response rate of imiquimod treatment for VaIN 2-3 were estimated. As a subgroup analysis, the CR rates and response rates were compared between women with and without a history of hysterectomy, and the rate ratio was calculated. RESULTS Five articles described 28 women with VaIN 2-3 who underwent imiquimod treatment, and nine women with VaIN 2-3 were treated with imiquimod in our hospital. The discontinuation of the treatment was required in only one patient of the reported cases. The pooled CR rate and response rate of imiquimod, regardless of a history of hysterectomy, was 0.76 (95% CI, 0.59-0.87) and 0.89 (95% CI, 0.71-0.97), respectively. In the subgroup analysis, the CR rate in patients with hysterectomy was 0.98 (95% CI, 0.11-1.0) and in those without hysterectomy was 0.60 (95% CI, 0.30-0.84), and the rate ratio was 0.83 (95% CI, 0.48-1.19). The pooled response rates with and without a history of hysterectomy were not estimated, and the rate ratio was 0.83 (95% CI, 0.54-1.09). CONCLUSION Imiquimod can be an effective treatment for vaginal intraepithelial neoplasia 2-3.
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2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis 2020; 24:102-131. [PMID: 32243307 PMCID: PMC7147428 DOI: 10.1097/lgt.0000000000000525] [Citation(s) in RCA: 505] [Impact Index Per Article: 126.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Yao H, Zhang H, Pu X, Shi L, Zhang Y, Wang P, Zhang G, Zhou Z, Zhou W, Wang X. Photodynamic therapy combined with carbon dioxide laser for low-grade vaginal intraepithelial neoplasia: A retrospective analysis. Photodiagnosis Photodyn Ther 2020; 30:101731. [PMID: 32171880 DOI: 10.1016/j.pdpdt.2020.101731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/09/2020] [Accepted: 03/09/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with a carbon dioxide laser (CO2 laser + PDT) versus CO2 laser for the treatment of low-grade vaginal intraepithelial neoplasms (vaginal LSIL). METHODS We recruited 40 patients with vaginal LSIL and persistent HR-HPV infection and divided these individuals into two groups. The CO2 laser + PDT group (20 patients) received one CO2 laser treatment and three treatments of ALA-PDT over a one-week interval. The CO2 laser group (20 patients) received up to three CO2 laser treatments. All patients were followed up at 1 month, 3 month, 6 month and 1 year. Hybrid capture HPV DNA assay and colposcopic biopsy were performed for both groups before treatment and during each of the follow-ups. Adverse effects were also assessed. RESULTS The complete remission (CR) rates were 65 % (13/20) in the CO2 laser group and 85 % (17/20) in the CO2 laser + PDT group (p > 0.05). HR-HPV remission rates were 25 % (5/20) in the CO2 laser group and 95 % (19/20) in the CO2 laser + PDT group (p < 0.05) at one year after treatment. In the CO2 laser group, one patient experienced severe bleeding during treatment. Twelve patients had varying degrees of adhesions and vaginal scar stenosis. One patient underwent vaginal "dead angle" after repeated CO2 laser treatment. No severe adverse events or systemic side effects were observed in the CO2 + PDT group. CONCLUSION Topical ALA-PDT combined with CO2 laser is an effective, safe, and well-tolerated treatment for vaginal LSIL and HR-HPV infections.
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Affiliation(s)
- Hongxia Yao
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Haiyan Zhang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China
| | - Xiaowen Pu
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Lei Shi
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Yunfeng Zhang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Peiru Wang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Guolong Zhang
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Zhongxia Zhou
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China
| | - Weiqiang Zhou
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, 200040, China.
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200443, China.
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Gorostidi M, Lekuona A, Juaristi A, Baiocchi G. Vaginal carcinoma after cervical dysplasia. Int J Gynecol Cancer 2020; 30:265-273. [PMID: 31911538 DOI: 10.1136/ijgc-2019-001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mikel Gorostidi
- Gynecology Oncology Section, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | - Arantza Lekuona
- Obstetrics and Gynecology, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | - Arantxa Juaristi
- Pathology Department, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
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Alfonzo E, Holmberg E, Sparén P, Milsom I, Strander B. Risk of vaginal cancer among hysterectomised women with cervical intraepithelial neoplasia: a population-based national cohort study. BJOG 2019; 127:448-454. [PMID: 31769577 DOI: 10.1111/1471-0528.16028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the risk of vaginal cancer among hysterectomised women with and without cervical intraepithelial neoplasia (CIN). DESIGN Population-based national cohort study. SETTING AND POPULATION All Swedish women, 5 million in total, aged 20 and up, 1987-2011 using national registries. METHODS The study cohort was subdivided into four exposure groups: hysterectomised with no previous history of CIN3 and without prevalent CIN at hysterectomy; hysterectomised with a history of CIN3/adenocarcinoma in situ (AIS); hysterectomised with prevalent CIN at hysterectomy; non-hysterectomised. MAIN OUTCOME MEASURE Vaginal cancer. RESULTS We identified 898 incident cases of vaginal cancer. Women with prevalent CIN at hysterectomy and those with a history of CIN3/AIS had incidence rates (IR) of vaginal cancer of 51.3 (95% CI 34.4-76.5) and 17.1 (95% CI 12.5-23.4) per 100 000, respectively. Age-adjusted IR-ratios (IRRs) compared with hysterectomised women with benign cervical history were 21.0 (95% CI 13.4-32.9) and 5.81 (95% CI 4.00-8.43), respectively. IR for non-hysterectomised women was 0.87 (95% CI 0.81-0.93) and IRR was 0.37 (95% CI 0.30-0.46). In hysterectomised women with prevalent CIN, the IR remained high after 15 years of follow up: 65.7 (95% CI 21.2-203.6). CONCLUSIONS Our findings suggest that hysterectomised women with prevalent CIN at surgery should be offered surveillance. Hysterectomised women without the studied risk factors have a more than doubled risk of contracting vaginal cancer compared with non-hysterectomised women in the general population. Still, the incidence rate does not justify screening. TWEETABLE ABSTRACT High risk of contracting vaginal cancer among hysterectomised women having prevalent CIN at surgery.
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Affiliation(s)
- Emilia Alfonzo
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Holmberg
- Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden.,Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Strander
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden
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Townsend JS, Puckett M, Gelb CA, Whiteside M, Thorsness J, Stewart SL. Improving Knowledge and Awareness of Human Papillomavirus-Associated Gynecologic Cancers: Results from the National Comprehensive Cancer Control Program/Inside Knowledge Collaboration. J Womens Health (Larchmt) 2018; 27:955-964. [PMID: 30129896 DOI: 10.1089/jwh.2018.7289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 16,000 women are diagnosed with a human papillomavirus (HPV)-associated gynecologic cancer every year. Because most of these cancers are preventable, correct and appropriate information about the HPV vaccine and cervical cancer screening can help reduce incidence. MATERIALS AND METHODS The Centers for Disease Control and Prevention created Inside Knowledge: Get the Facts About Gynecologic Cancer campaign materials, which were used by seven National Comprehensive Cancer Control Program recipients in tailored educational sessions on gynecologic cancer with women and healthcare providers in the community setting. Session participants completed presession and postsession questionnaires. Differences in knowledge and intentions were assessed using chi-square tests for women in the general public, obstetricians/gynecologists (OB/GYNs), primary care physicians (PCPs), and other healthcare providers. RESULTS Women's knowledge improved significantly presession to postsession that HPV causes vaginal (39%-65%, p < 0.001) and vulvar cancers (26%-60%, p < 0.001), but postsession few women correctly identified all HPV-associated gynecologic cancers (15%). From presession to postsession, more women were able to correctly identify recommended age groups for whom the HPV vaccine is recommended (15%-30%, p < 0.001), and that the Pap test only screens for cervical cancer (58%-73%, p < 0.001). Among providers, OB/GYNs had more baseline knowledge of HPV-associated gynecologic cancers than other providers. Postsession, PCPs and other providers increased their knowledge of HPV vaccine recommended age groups (33%-71% and 23%-61%, respectively), and the 3-year recommended screening interval for the Pap test (73%-91% and 63%-85%, respectively). HPV vaccine knowledge did not show significant improvement among OB/GYNs postsessions. CONCLUSIONS Women and healthcare providers who attended the Inside Knowledge sessions significantly improved their knowledge of HPV-associated gynecologic cancers. Additional educational activities during the sessions that support distinguishing between HPV-associated versus other gynecologic cancers and clarify HPV vaccine recommendations may help with further increases in knowledge.
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Affiliation(s)
- Julie S Townsend
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Mary Puckett
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Cynthia A Gelb
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Martin Whiteside
- 2 Office of Cancer Surveillance , Division of Policy, Planning and Assessment, Tennessee Department of Health, Nashville, Tennessee
| | - Julia Thorsness
- 3 Alaska Comprehensive Cancer Control Program , Chronic Disease Prevention Health Promotion, Division of Public Health, Alaska Department of Health and Human Services, Anchorage, Alaska
| | - Sherri L Stewart
- 1 Division of Cancer Prevention and Control, Centers for Disease Control and Prevention , Atlanta, Georgia
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Kusunoki S, Huang KG, Magno A. Carcinoma In Situ with Pelvic Cystic Formation in Early Cervical Cancer After Hysterectomy and Long-Term Treatment for Vaginal Intraepithelial Neoplasma. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Soshi Kusunoki
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Angelito Magno
- Department of Obstetrics and Gynecology, University of Perpetual Help Las Pinas and De La Salle University Medical Center, Cavite, Philippines
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Lamos C, Mihaljevic C, Aulmann S, Bruckner T, Domschke C, Wallwiener M, Paringer C, Fluhr H, Schott S, Dinkic C, Brucker J, Golatta M, Gensthaler L, Eichbaum M, Sohn C, Rom J. Detection of Human Papillomavirus Infection in Patients with Vaginal Intraepithelial Neoplasia. PLoS One 2016; 11:e0167386. [PMID: 27907089 PMCID: PMC5132291 DOI: 10.1371/journal.pone.0167386] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/14/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Vaginal intraepithelial neoplasia (VAIN) is a pre-malignant lesion, potentially leading to vaginal cancer. It is a rare disease, representing less than 1% of all intraepithelial neoplasia of the female genital tract. Similar to cervical intraepithelial neoplasia (CIN), there are three different grades of VAIN. VAIN 1 is also known as a low-grade squamous intraepithelial lesion (LSIL), whereas VAIN 2 and VAIN 3 both represent high-grade squamous intraepithelial lesions (HSIL). Risk factors for the development of VAIN are similar to those for cervical neoplasia, i.e. promiscuity, starting sexual activity at an early age, tobacco consumption and infection with human papillomavirus (HPV). However, compared to other intraepithelial neoplasia such as CIN or VIN (vulvar intraepithelial neoplasia), there still is little understanding about the natural course of VAIN and its capacity for pro- or regression. Furthermore, there is controversial data about the HPV detection rate in VAIN lesions. PATIENTS AND METHODS 67 patients with histologically confirmed VAIN, who were diagnosed between 2003 and 2011 at the University Women´s Hospital of Heidelberg Germany, were included in this study. The biopsies of all participating patients were subjected to HPV genotyping. GP-E6/E7 Nested Multiplex PCR (NMPCR) was used to identify and genotype HPV. Eighteen pairs of type-specific nested PCR primers were assessed to detect the following "high-risk" HPV genotypes: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68, as well as the "low-risk" genotypes 6/11, 42, 43 and 44. The data was analyzed with the software SAS (Statistical Analysis System). RESULTS All 67 cases were eligible for DNA analysis. The median age was 53 years. The largest group with 53% (n = 36) was formed by women, who were first diagnosed with VAIN between the age of 41 to 60 years. 50% (n = 37) of the patients presented a VAIN in the upper 1/3 of the vagina. 58 (87%) were diagnosed with HSIL (VAIN). The median age in patients with LSIL (VAIN) was 53 years and in patients with HSIL (VAIN) 53.5 years. 12 women (18%) had an immunosuppression. HPV positivity was confirmed in 37 patients (55%). Except for a single patient, who had a triple infection with HPV types 6/11, 16 and 68, only infections with one single HPV genotype were detected. An infection with the HPV genotypes 31, 39, 45, 51, 58, 59, 66, 42, 43 and 44 couldn't be found in any of the patients. In 28 patients with diagnosed VAIN, an infection with HPV 16 could be shown, 24 (86%) of them were diagnosed with a HSIL (VAIN). 16 (24%) women presented condylomata and 13 of them (81%) had a positive HPV status. However, only 47% of the women without condylomata presented a positive HPV status, resulting in a significant correlation (p = 0.0164) between condylomata and HPV infection. In 28 of all 67 patients (42%), recurrence of the neoplasia occurred. CONCLUSION HPV 16 is the main virus-type to be associated with the development of a VAIN. Also, HPV 16 infection, VIN or condylomata acuminata in the past medical history seemed to be significant factors for early relapse.
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Affiliation(s)
- Cristina Lamos
- Department of Dermatology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Charlotte Mihaljevic
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | | | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Christoph Domschke
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Markus Wallwiener
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Carmen Paringer
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Herbert Fluhr
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Christine Dinkic
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Janina Brucker
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | | | - Michael Eichbaum
- Department of Gynecology and Obstetrics, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
| | - Joachim Rom
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany
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Oud L. Contemporary Trends of Reported Sepsis Among Maternal Decedents in Texas: A Population-Based Study. Infect Dis Ther 2015; 4:321-35. [PMID: 26334239 PMCID: PMC4575290 DOI: 10.1007/s40121-015-0086-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Recent studies indicate that death certificate-based single-cause-of-death diagnoses can substantially underestimate the contribution of sepsis to mortality in the general population and among maternal decedents. There are no population-based data in the United States on the patterns of the contribution of sepsis to pregnancy-associated deaths. Methods We studied the Texas Inpatient Public Use Data File to identify pregnancy-associated hospitalizations with reported hospital death during 2001–2010. We then examined the annual reporting of sepsis, and that of other reported most common causes of maternal death, including hemorrhage, embolism, preeclampsia/eclampsia, cardiovascular conditions, cardiomyopathy, cerebrovascular accidents, and anesthesia complications. The annual rate of sepsis among decedents, its trend over time, and changes of its annual rank among other examined potential causes of maternal death were assessed. Results There were 557 pregnancy-associated hospital deaths during study period. Sepsis was reported in 131 (23.5%) decedents. Sepsis has been increasingly reported among decedents, rising by 9.1%/year (P = 0.0025). The rank of sepsis, as compared to the other examined potential causes of maternal death rose from the 5th in 2001 to 1st since 2008. At the end of the last decade, sepsis has been reported in 28.1% of pregnancy-associated deaths. More than one potential cause of maternal death was reported in 39% of decedents. Conclusion Sepsis has become the most commonly reported potential cause of death among maternal decedents in the present cohort, noted in over 1 in 4 fatal hospitalizations by the end of the last decade. Although causality cannot be inferred from administrative data, given its known contribution to maternal death, it is likely that sepsis plays an increasing role in fatal maternal hospital outcomes. The prevalent co-reporting of multiple potential causes of maternal death in the present cohort underscores the complexity of determining the sources of evolving rise of maternal mortality. Electronic supplementary material The online version of this article (doi:10.1007/s40121-015-0086-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lavi Oud
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA.
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Abstract
OBJECTIVE To review the outcomes of those women who underwent hysterectomy because of an abnormal cervical smear where local excision was considered technically not possible. MATERIALS AND METHODS A retrospective chart review was performed for all women who had hysterectomy at a university-affiliated hospital, carried out during the period between January 2000 and June 2012, because of cervical neoplasia. RESULTS Fifty-six women were identified. The mean (standard deviation [SD]) age of the women at the time of hysterectomy was 61.4 (8.2) years. Two women (3.6%) had cervical carcinoma, and adjuvant treatment was required in both cases. Being postmenopausal and older than 50 years and having a history of previous local excisional procedure were associated with a higher risk of high-grade cervical intraepithelial neoplasia found during hysterectomy (p > .005). During a mean (SD) follow-up of 42.3 (30.8) months after hysterectomy, 35.7% of women had persistent cytologic abnormality after hysterectomy, with 19.6% having subsequent histologically proven vaginal intraepithelial neoplasia (VAIN). Women's age, route of hysterectomy, previous local excision, degree of cytologic abnormality before hysterectomy, presence of VAIN before hysterectomy, and final histology of the hysterectomy specimen could not predict subsequent VAIN after hysterectomy. CONCLUSIONS Hysterectomy seems to be an appropriate option in management, but further surgery or adjuvant therapy may be needed. Women should also be aware of the possibilities of persistent cytologic abnormalities including VAIN, but unfortunately, no predictive factor for its occurrence can be identified.
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Wang Y, Kong WM, Wu YM, Wang JD, Zhang WY. Therapeutic effect of laser vaporization for vaginal intraepithelial neoplasia following hysterectomy due to premalignant and malignant lesions. J Obstet Gynaecol Res 2014; 40:1740-7. [PMID: 24888942 DOI: 10.1111/jog.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/13/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Yan Wang
- Department of Gynecological Oncology; Beijing Obstetrics and Gynecology Hospital of Capital Medical University; Beijing China
| | - Wei-Min Kong
- Department of Gynecological Oncology; Beijing Obstetrics and Gynecology Hospital of Capital Medical University; Beijing China
| | - Yu-Mei Wu
- Department of Gynecological Oncology; Beijing Obstetrics and Gynecology Hospital of Capital Medical University; Beijing China
| | - Jian-Dong Wang
- Department of Gynecological Oncology; Beijing Obstetrics and Gynecology Hospital of Capital Medical University; Beijing China
| | - Wei-Yuan Zhang
- Department of Gynecological Oncology; Beijing Obstetrics and Gynecology Hospital of Capital Medical University; Beijing China
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Li Z, Barron S, Hong W, Karunamurthy A, Zhao C. Surveillance for recurrent cancers and vaginal epithelial lesions in patients with invasive cervical cancer after hysterectomy: are vaginal cytology and high-risk human papillomavirus testing useful? Am J Clin Pathol 2013; 140:708-14. [PMID: 24124151 DOI: 10.1309/ajcph4afszhu8ekk] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To examine whether women who have had a hysterectomy for cervical cancer may be at an increased risk of vaginal epithelial lesions. METHODS We studied 147 patients with invasive cervical carcinoma (76 squamous cell carcinomas [SCCs], 60 adenocarcinomas [ADCs], and 11 adenosquamous cell carcinomas) who were treated by hysterectomy and had vaginal pathologic follow-up for a mean period of 43.3 months. RESULTS Of the patients, 15.0% (22/147) developed vaginal intraepithelial neoplasia (VAIN) or recurrence after hysterectomy, including two recurrent carcinomas and eight high-grade VAINs. More important, these high-grade VAINs or recurrent carcinomas were detected only in patients with cervical SCC within the first two years after hysterectomy but not in patients with cervical ADC. Eleven (23.4%) of 47 patients had at least one positive high-risk human papillomavirus (hrHPV) testing result during the follow-up period, and VAIN was detected in 54.5% (6/11) of patients with an hrHPV-positive result compared with 16.7% (6/36) with an hrHPV-negative result. CONCLUSIONS Our results indicate that women with cervical cancer are at an increased risk of VAIN besides recurrence, and women with cervical SCC are more prone to high-grade VAIN/recurrence, especially within the first two years after hysterectomy. The significantly increased detection rate of VAINs/recurrence in the hrHPV-positive group suggests vaginal cytology and HPV cotesting might be the preferred method for surveillance in these women.
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Affiliation(s)
- Zaibo Li
- Department of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Stacey Barron
- Department of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - Wei Hong
- Department of Pathology, Conemaugh Memorial Medical Center, Johnstown, PA
| | | | - Chengquan Zhao
- Department of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, PA
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Baldauf JJ, Averous G, Baulon E, Thoma V, Talha-Vautravers A, Sananes N, Akladios Y. Neoplasias intraepiteliales del cuello uterino. EMC - GINECOLOGÍA-OBSTETRICIA 2013; 49:1-23. [DOI: 10.1016/s1283-081x(13)65435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Liu X, Yue Y, Zong S. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report. Pak J Med Sci 2013; 29:1068-70. [PMID: 24353691 PMCID: PMC3817789 DOI: 10.12669/pjms.294.3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/23/2013] [Accepted: 05/25/2013] [Indexed: 11/15/2022] Open
Abstract
We present a case report of secondary vaginal cancer after complete hysterectomy due to myoma that was complicated by low-grade cervical intraepithelial neoplasia (CIN I) and human papilloma virus (HPV) infection. After complete hysterectomy, the HPV DNA level in the vaginal tissue was obviously increased, and vaginal cancer was diagnosed 6 months later. We conclude that HPV infection can cause vaginal cancer after complete hysterectomy in cases complicated by CIN. Therefore, HPV should be regularly assessed during the postoperative follow-up period.
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Affiliation(s)
- Xiaoxia Liu
- Xiaoxia Liu, PhD, Obstetrics and Gynecology Center, First Hospital of Jilin University Norman Bethune, Changchun, 130021, China
| | - Ying Yue
- Ying Yue, PhD, Obstetrics and Gynecology Center, First Hospital of Jilin University Norman Bethune, Changchun, 130021, China
| | - Shan Zong
- Shan Zong, MD, Obstetrics and Gynecology Center, First Hospital of Jilin University Norman Bethune, Changchun, 130021, China
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Baldauf JJ, Averous G, Baulon E, Thoma V, Talha-Vautravers A, Sananes N, Akladios Y. Néoplasies intraépithéliales du col. EMC - GYNÉCOLOGIE 2013; 8:1-21. [DOI: 10.1016/s0246-1064(12)54837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Nicolas F, Vandenbroucke L, Voltzenlogel MC, Lavoué V, Henno S, Levêque J. [Are vaginal pap smear necessary after total hysterectomy for CIN3?]. ACTA ACUST UNITED AC 2013; 41:196-200. [PMID: 23499311 DOI: 10.1016/j.gyobfe.2013.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 01/29/2013] [Indexed: 11/29/2022]
Abstract
The practice of vaginal smears after total hysterectomy should be discussed according to the indication for hysterectomy. We have thus performed a literature review using PubMed medical database with selection of articles presenting a practical interest for clinicians. The practice of vaginal smears after endometrial cancer can be abandoned, but in case of cervical cancer it improves the performance of clinical examination in the early follow-up (in the first 5 years of follow-up) especially in early diagnosis of subclinical recurrence. After this period, the interest of vaginal smears drop drastically and the follow-up is mainly clinical. When hysterectomy is proposed as part of cervical intraepithelial neoplasia (particularly when associated uterine lesions and cervical conization not accessible), the risk of vaginal recurrence of HPV-induced pathology fully justifies an annual monitoring (recurrences or virus-induced lesions are seen up to 25 years after surgery). Finally, after hysterectomy for benign uterine non-HPV-induced, there is no need to propose a systematic follow-up cytology.
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Affiliation(s)
- F Nicolas
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
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Bansal M, Li Z, Zhao C. Correlation of histopathologic/cytologic follow-up findings with vaginal ASC-US and ASC-H Papanicolaou test and HPV test results. Am J Clin Pathol 2012; 137:437-43. [PMID: 22338056 DOI: 10.1309/ajcp9to1omxlddpi] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Current American Society of Colposcopy and Cervical Pathology recommendations about human papillomavirus (HPV) triage and further management for atypical squamous cells are pertinent to cervical Papanicolaou (Pap) tests. There are limited data on HPV detection in vaginal liquid-based cytology (LBC) specimens. The aims of this study were to determine whether adjunctive high-risk (HR)-HPV testing is useful for disease risk assessment in women with vaginal atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells, cannot exclude HSIL (ASC-H) Pap results. We identified 1,125 ASC-US and 36 ASC-H vaginal Pap results with HR-HPV testing. Of the cases, 244 (21.7%) ASC-US and 21 (58%) ASC-H were HR-HPV+. Among ASC-US HR-HPV+ cases, 47.8% had a squamous intraepithelial lesion (SIL) compared with 4.7% of HR-HPV- cases. Among ASC-H HR-HPV+ cases, 75% (12/16) had SIL compared with 31% (4/13) in HR-HPV- cases. Our results indicate that HPV triage testing is a reasonable and cost-effective approach for women with ASC-US vaginal Pap results and also a useful option for women with ASC-H vaginal Pap results.
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Posthysterectomy cytology screening: indications and clinical implications. J Low Genit Tract Dis 2011; 16:45-8. [PMID: 22207152 DOI: 10.1097/lgt.0b013e31822ebf69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the results of patients who were referred for posthysterectomy of abnormal cytology based on screening indications. MATERIALS AND METHODS We performed a retrospective review of 64 patients who have been referred for posthysterectomy vaginal colposcopy to the gynecologic oncology service. Patients' demographics, clinical features, reason for screening, and final diagnosis were recorded. Patients were divided into 2 groups based on posthysterectomy screening guidelines. Group A was considered to have undergone unnecessary screening based on national guidelines, and group B had risk factors that appropriately called for continued surveillance. The number of colposcopic examinations and the incidence of neoplasia were recorded for each group. RESULTS The mean age of the patients was 65 years (range = 35-95 y). Group A included 22 patients with history of abnormal cytology posthysterectomy for benign disease. Of the 22 abnormal cytology results, 21 were low-grade squamous intraepithelial lesion (n = 14) or atypical squamous cells of undetermined significance (n = 7) with 1 high-grade squamous intraepithelial lesion. After referral and colposcopy of this group, no neoplasia was found. Group B included 42 total patients. Of these 42 patients, 20 (48%) had a history of cervical intraepithelial neoplasia, 12 (28%) had a history of vaginal intraepithelial neoplasia, 6 (14%) had history of cervical cancer, 2 (5%) had history of diethylstilbestrol exposure, and 2 (5%) had a history of radiation therapy. In group B, 8 (9%) and 1 (2%) of the patients had vaginal intraepithelial neoplasia 2/3 and squamous cell carcinoma, respectively. CONCLUSIONS Current national guidelines are appropriate. Adherence to these guidelines will decrease intervention and not affect the detection of vaginal neoplasia. Patients with risk factors for lower genital tract neoplasia warrant continued screening after hysterectomy.
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Bansal M, Austin RM, Zhao C. Correlation of Histopathologic Follow-up Findings With Vaginal Human Papillomavirus and Low-Grade Squamous Intraepithelial Lesion Papanicolaou Test Results. Arch Pathol Lab Med 2011; 135:1545-9. [DOI: 10.5858/arpa.2010-0658-oa] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Data on high-risk human papillomavirus (hrHPV) DNA test results in vaginal, liquid-based cytology (LBC) specimens and corresponding cytologic and histopathologic correlation data are limited.
Objective.—To analyze follow-up correlation data associated with vaginal (after hysterectomy) low-grade squamous intraepithelial lesion (LSIL) LBC and hrHPV test results.
Design.—Hospital records were searched for vaginal LSIL LBC and hrHPV results between July 1, 2005, and July 30, 2009. Histopathologic and Papanicolaou test follow-up correlation data were analyzed.
Results.—During the study period, 2892 patients with test results from both posthysterectomy vaginal LBC and hrHPV were identified: 148 (5.1%) of the patients had vaginal Papanicolaou test results reported as LSIL, with hrHPV detected in 113 of the 148 patients (76.4%). Of 148 patients, 59 of those with vaginal LSIL including 48 (81.4%) with positive HPV testing and 11 (18.6%) with negative HPV testing results had a follow-up vaginal biopsy. Histopathologic vaginal intraepithelial neoplasia (VAIN) 2/3 was diagnosed in 7 of 59 patients (11.9%) with biopsies. In all 7 patients who were diagnosed with VAIN 2/3, hrHPV was detected in the LBC vial. No VAIN 2/3 diagnoses were documented in the biopsy specimens from the 11 patients with hrHPV− LSIL Papanicolaou test results. Histopathologic VAIN 2/3 was diagnosed from vaginal biopsies in 7 of the 48 patients (14.6%) with vaginal hrHPV+ LSIL test results.
Conclusions.—Sensitivity and specificity of hrHPV test results associated with histopathologic follow-up diagnoses of VAIN 2/3 in patients with vaginal LSIL results were 100% and 21.2%, respectively. The positive predictive value of a vaginal hrHPV+ LSIL result for a subsequent histopathologic VAIN 2/3 diagnosis was 14.6%. No cases of VAIN 2/3 were diagnosed in the 11 patients with vaginal hrHPV− LSIL results. Correlations of vaginal cytologic, histopathologic, and human papillomavirus findings were quite similar to correlation findings previously reported in older women with cervical LSIL test results.
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Yoshinaga M, Hamada T, Orita Y, Yoshitomi Shintomo N, Matsuo T, Tsuji T, Tabata K, Douchi T. Clinical outcome of stage Ia1 squamous cell carcinoma of the uterine cervix and pathological findings of initial conization. J Obstet Gynaecol Res 2011; 37:1645-9. [DOI: 10.1111/j.1447-0756.2011.01590.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jakobsson M, Pukkala E, Paavonen J, Tapper A, Gissler M. Cancer incidence among Finnish women with surgical treatment for cervical intraepithelial neoplasia, 1987–2006. Int J Cancer 2010; 128:1187-91. [DOI: 10.1002/ijc.25428] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maija Jakobsson
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - Anna‐Maija Tapper
- Department of Obstetrics and Gynaecology, University Hospital, Helsinki, Finland
| | - Mika Gissler
- THL National Institute for Health and Welfare, Information Department, Helsinki, Finland
- Nordic School of Public Health, Gothenburg, Sweden
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Boonlikit S, Noinual N. Vaginal intraepithelial neoplasia: A retrospective analysis of clinical features and colpohistology. J Obstet Gynaecol Res 2010; 36:94-100. [DOI: 10.1111/j.1447-0756.2009.01108.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Kim HS, Park NH, Park IA, Park JH, Chung HH, Kim JW, Song YS, Kang SB. Risk factors for recurrence of vaginal intraepithelial neoplasia in the vaginal vault after laser vaporization. Lasers Surg Med 2009; 41:196-202. [DOI: 10.1002/lsm.20741] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Waxman AG. Cervical cancer screening in the early post vaccine era. Obstet Gynecol Clin North Am 2009; 35:537-48; vii. [PMID: 19061815 DOI: 10.1016/j.ogc.2008.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Pap test is the foundation of cervical cancer screening in North America and most industrialized countries. It has been widely used in the United States since the 1950s. But are our current screening guidelines still justified? In this article, the author reviews the current recommendations for cervical cancer screening by the American Cancer Society (ACS) and the American College of Obstetricians and Gynecologists (ACOG) and the evidence supporting them, reviews the relative efficacy of liquid-based cytology versus the conventional Pap smear, and discusses the role of HPV DNA testing in primary screening.
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Affiliation(s)
- Alan G Waxman
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, University of New Mexico, MSC10 5580, Albuquerque, NM 87131-0001, USA.
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