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  • Title: Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia.
    Author: Jentschke M, Hoffmeister V, Soergel P, Hillemanns P.
    Journal: Arch Gynecol Obstet; 2016 Feb; 293(2):415-9. PubMed ID: 26232937.
    Abstract:
    PURPOSE: To characterize the clinical presentation and outcome of patients with vaginal intraepithelial neoplasia (VAIN). METHODS: Medical records of 65 women with VAIN treated between 2005 and 2012 at the colposcopy clinic of a German university hospital were retrospectively evaluated for VAIN grade, HPV status, VAIN localization, treatment method and relapse rate. Follow-up data were available for 53 patients (82 %). RESULTS: Mean age was 61 years (range 32-89 years). Most lesions (55 %) were found in the upper vaginal third; 42 % were multifocal. Multifocal VAIN was more frequently HPV positive than single lesions (p = 0.059). Of all women with known HPV status, 83 % were high-risk (HR) HPV positive and 32 % had a simultaneous CIN earlier or at the same time as the VAIN, mostly CIN 3 (66 %). Two-thirds had a hysterectomy in the past, often because of high-grade CIN. Most cases of VAIN were treated with CO2 laser vaporization. A relapse of the disease could be confirmed for 57 %. HR-HPV positive VAIN was significantly more likely to relapse than HR-HPV negative VAIN (p = 0.005). There were three cases of vaginal cancer with surrounding VAIN 3 or vaginal cancer diagnosed after primary treatment of VAIN 3 and one case of vaginal cancer during follow-up 22 months after the first laser vaporization. All of these cases were HR-HPV positive. CONCLUSIONS: VAIN has a high relapse rate and a high progression rate to invasive cancer especially if HR-HPV positive. Therefore, adequate follow-up examinations are mandatory.
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