High-grade vaginal intraepithelial neoplasia: can we be selective about who we treat?
BJOG
; 120(7): 887-93, 2013 Jun.
Article
em En
| MEDLINE
| ID: mdl-23551637
ABSTRACT
OBJECTIVE:
To determine the role of conservative management in high-grade vaginal intraepithelial neoplasia (HG VaIN).DESIGN:
Retrospective observational study.SETTING:
Northern Gynaecological Oncology Centre, Gateshead, UK. POPULATION A total of 100 women with histologically-proven HG VaIN.METHODS:
Review of patient records from 1995 to 2011. MAIN OUTCOMEMEASURES:
Rates of progression to cancer, treatment remission, and disease recurrence, particularly post-treatment when vaginoscopy is normal but cytology is abnormal.RESULTS:
Of 100 women referred, 69 underwent initial treatment of whom 47 (68%) went into remission of these, seven developed a recurrence after a median follow-up of 29 months (range 15-214 months). Of the 31 women managed conservatively with cytological and vaginoscopic surveillance, no cancers developed after a median follow-up of 35 months (range 2-230 months). Rate of overall progression to cancer was 3% and all were detected among the initial treatment group after a median of 59 months (range 8-249 months). Post-treatment, when normal vaginoscopy was accompanied by abnormal cytology, two categories existed. Of 24 cases with low-grade cytological abnormality, recurrence of HG VaIN occurred in seven (29%) after a median follow-up of 12 months (range 2-110 months). Of 19 cases with HG cytological abnormality, 15 (79%) developed recurrence at a median follow-up of 7 months (range 2-21 months), giving a hazard ratio 5.6 (95% confidence interval 2.0-15.5, P = 0.001).CONCLUSIONS:
It is possible to select women with HG VaIN for conservative surveillance with excellent results. The majority of women undergoing initial treatment will enter remission. Post-treatment, if cytological abnormality develops in the presence of normal vaginoscopy, the majority of women will develop histological HG VaIN recurrence.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Vagina
/
Neoplasias Vaginais
/
Carcinoma in Situ
/
Conduta Expectante
Tipo de estudo:
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
Limite:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
BJOG
Assunto da revista:
GINECOLOGIA
/
OBSTETRICIA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Reino Unido