Vaginal intraepithelial neoplasia: Risk factors for persistence, recurrence, and invasion and its management


      OBJECTIVES: Our purpose was to profile patients with vaginal intraepithelial neoplasia, evaluate the response to treatment, and define risk factors for persistence and progression. STUDY DESIGN: We reviewed records and histopathology slides of 94 patients with vaginal intraepithelial neoplasia diagnosed from 1977 to 1986. For 74 patients with follow-up, we evaluated risk factors by univariate and multivariate analyses. RESULTS: Sixty-four of 94 patients (68%) had prior or concurrent anogenital squamous neoplasia, including 21 with invasive and 43 with intraepithelial. Twenty-three had prior radiotherapy, 10 had anogenital neoplastic syndrome, and 11 were immunosuppressed. In 52 of 74 treated patients (70%), vaginal intraepithelial neoplasia went into remission after a single treatment. In 18 patients (24%) recurrent vaginal intraepithelial neoplasia went into remission after chemosurgery, upper vaginectomy, or other treatments; in 4 (5%) it progressed to invasion. Significant multivariate risk factors for persistence or progression were multifocal lesions and anogenital neoplastic syndrome but not vaginal intraepithelial neoplasia grade, associated cervical neoplasia, or immunosuppression. CONCLUSIONS: Although most vaginal intraepithelial neoplasia goes into remission after treatment, 5% of cases may progress from occult foci to invasion in spite of close follow-up. (Am J. Obstet Gynecol 1997;176:93-9.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sillman FH
        • Sedlis A
        • Boyce J.
        A review of lower genital intraepithelial neoplasia and the use of topical 5-fluorouracil.
        Obstet Gynecol Surv. 1985; 40: 190-220
        • Sillman FH
        • Boyce J
        • Macasaet M
        • Nicastri A.
        5-Fluorouracil/chemosurgery in the treatment of intraepithelial neoplasia of the lower genital tract.
        Obstet Gynecol. 1981; 58: 356-360
        • Sillman FH
        • Sedlis A
        • Boyce J.
        5-FU/chemosurgery for difficult lower genital intraepithelial neoplasia.
        Contemp Obstet Gynecol. 1985; 27: 79-101
        • Sillman FH
        • Stanek A
        • Sedlis A
        • Rosenthal J
        • Lanks KW
        • Buchhagen D
        • et al.
        The relationship between human papillomavirus and lower genital intraepithelial neoplasia in immunosuppressed women.
        Am J Obstet Gynecol. 1984; 150: 300-308
        • Sedlis A
        • Robboy SJ.
        Diseases of the vagina.
        in: Blaustein's pathology of the female genital tract. Springer-Verlag, New York1987: 111-114
        • Dixon WJ.
        BMDP statistical software.
        University of California Press, Berkeley1990
        • Kelsey JL
        • Thompson WD
        • Evans AS.
        Methods in observational epidemiology.
        Oxford University Press, New York:1986
        • Benedet JL
        • Sanders BH.
        Carcinoma in situ of the vagina.
        Am J Obstet Gynecol. 1984; 148: 695-700
        • Sillman FH
        • Sedlis A.
        Anogenital HPV/neoplasia in immunosuppressed women: an update.
        Dermatol Clin North Am. 1991; 9: 353-369
        • Hoffman MS
        • DeCesare SL
        • Roberts WS
        • Fiorica JV
        • Finan MA
        • Cavanagh D.
        Upper vaginectomy for in situ and occult, superficially invasive carcinoma of the vagina.
        Am J Obstet Gynecol. 1992; 166: 30-33
        • Ireland D
        • Monaghan JM.
        The management of the patient with abnormal cytology following hysterectomy.
        Br J Obstet Gynaecol. 1988; 95: 973-975
        • Soutter WP.
        The treatment of vaginal intraepithelial neoplasia after hysterectomy.
        Br J Obstet Gynaecol. 1988; 95: 961-962
        • Hoffman MS
        • Roberts WS
        • LaPolla JP
        • Fiorica JV
        • Cavanagh D.
        Laser vaporization of grade three vaginal intraepithelial neoplasia.
        Am J Obstet Gynecol. 1991; 165: 1342-1344
        • Audet-LaPointe P
        • Body G
        • Vauclair R
        • Drouim P
        • Ayoub J.
        Vaginal intraepithelial neoplasia.
        Gynecol Oncol. 1990; 36: 232-239
        • Woodman CBJ
        • Mould JJ
        • Jordan JA.
        Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy.
        Br J Obstet Gynaecol. 1988; 95: 976-979
        • Coppleson M
        • Atkinson KH
        • Dalrymple JC.
        Cervical squamous and glandular intraepithelial neoplasia.
        in: 2nd ed. Gynecologic oncology. Churchill Livingston, Edinburgh1992: 594
        • Fetters MD
        • Fischer G
        • Reed BD.
        Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease.
        JAMA. 1996; 275: 940-947
        • Piscitelli JT
        • Bastian LA
        • Wilkes A
        • Simel DL.
        Cytologic screening after hysterectomy for benign disease.
        Am J Obstet Gynecol. 1995; 173: 424-432