A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia

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• 作者：Camille C. Gunderson ; MD^a ; ^{camille-gunderson@ouhsc.edu} ; Elizabeth K. Nugent ; MD^a ; Stacie H. Elfrink ; MD^a ; Michael A. Gold ; MD^b ; Kathleen N. Moore ; MD ; MS^a
• 关键词：neoplasia ; vaginal dysplasia ; VAIN
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：208
• 期：5
• 页码：410.e1-410.e6
• 全文大小：777 K

文摘

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Objective

The purpose of this study was to review a large cohort of patients with vaginal intraepithelial neoplasia (VAIN) and to analyze the epidemiology and outcomes with various treatment modalities.

Study Design

A retrospective chart review was performed that encompassed patients who were treated for VAIN at a single center from 1990-2007. Demographics, disease characteristics, referring cytology, and histologic information were recorded. Primary outcome was recurrence or progression to carcinoma. Statistical analyses were performed with statistical software.

Results

One hundred sixty-three women were included in the study: median age, 50 years (range, 21-84 years); white, 87 % ; current or previous smokers, 35 % . At the time of diagnosis, 23 % of the women had VAIN1; 37 % of the women had VAIN2, and 35 % of the women had VAIN3. Referral Papanicolaou smear results of high-grade squamous intraepithelial lesion or atypical glandular cells revealed VAIN2 or VAIN3 in 89 % of cases (P = .0019) vs 53 % of cases with low-grade squamous intraepithelial lesion. The median follow-up period was 18 months (range, 1-194 months). VAIN1 was observed in 70 % of cases; 71 % of patients who were treated for VAIN1 had recurrence or progression. VAIN2 was treated in 77 % of patients; 53 % of those who were treated had recurrence or progression. VAIN3 was treated in 94 % of cases; 31 % of them had recurrence or progression. Risk of recurrence was not correlated to VAIN type (P = .3). Six carcinomas were discovered in patients with VAIN2 and VAIN3. Median time to progression was 17 months for VAIN1, 11 months for VAIN2, and 11 months for VAIN3 (P = .036).

Conclusion

Despite the subtype, VAIN often recurs but does so more quickly with higher grade dysplasia.