Journal article
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
International journal of gynecological cancer, Vol.33(4), pp.446-461
04/2023
DOI: 10.1136/ijgc-2022-004213
PMCID: PMC10086489
PMID: 36958755
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.
Details
- Title: Subtitle
- 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
- Creators
- Vesna Kesic - University of BelgradeXavier Carcopino - Aix-Marseille UniversitéMario Preti - Department of Surgical Sciences, University of Torino, Torino, ItalyPedro Vieira-Baptista - Hospital Lusiadas, Porto, PortugalFederica Bevilacqua - Department of Surgical Sciences, University of Torino, Torino, ItalyJacob BornsteinCyrus Chargari - Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, FranceMaggie Cruickshank - University of AberdeenEmre Erzeneoglu - Hacettepe UniversityNiccolò Gallio - Department of Surgical Sciences, University of Torino, Torino, ItalyMurat Gultekin - Hacettepe UniversityDebra Heller - Rutgers, The State University of New JerseyElmar Joura - Medical University of ViennaMaria Kyrgiou - Imperial Healthcare NHS Trust, Queen Charlotte's & Chelsea Hospital West London Gynaecological Cancer Centre, London, UKTatjana Madić - Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, SerbiaFrançois Planchamp - Institut BergoniéSigrid Regauer - Medical University of GrazOlaf Reich - Medical University of GrazBilal Esat Temiz - Hacettepe UniversityLinn WoelberJana Zodzika - Riga Stradiņš UniversityColleen Stockdale - University of Iowa
- Resource Type
- Journal article
- Publication Details
- International journal of gynecological cancer, Vol.33(4), pp.446-461
- Publisher
- BMJ Publishing Group Ltd
- DOI
- 10.1136/ijgc-2022-004213
- PMID
- 36958755
- PMCID
- PMC10086489
- ISSN
- 1048-891X
- eISSN
- 1525-1438
- Language
- English
- Electronic publication date
- 03/23/2023
- Date published
- 04/2023
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984380371502771
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