ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378
Ru
En

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention

DOI:10.31550/1727-2378-2020-19-1-44-50
Bibliography link: Zarochentseva N.V., Krasnopolsky V.I., Dzhidzhikhia L.K., Menshikova N.S., Baranov I.I., Rovinskaya O.V., Ashrafyan L.A., Kiselev V.I. Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention. Doctor.Ru. 2020; 19(1): 44–50. (in Russian) DOI: 10.31550/1727-2378-2020-19-1-44-50
Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention
4 February 16:52

Objective of the Review: to summarise scientific data on diagnostics, treatment and prevention of vaginal intraepithelial neoplasia (VAIN).

Key Points. VAIN is a rare asymptomatic pre-malignant condition. The key factors for VAIN are HPV infection and history of uterectomy. Diagnosis is based on cytologic screening, HPV testing, vaginoscopy, and biopsy. VAIN is treated with CO2 laser, loopelectroexcision, cavitationalultrasonic surgical aspiration (CUSA), radiation therapy, and other.

Conclusion. The risk of vaginal lesions in HPV positive patients cannot be ruled out even following uterotomy. Vaginal examination should be performed during every colposcopy. HPV vaccination is a useful measure to prevent HPV associated cancer and premalignancy including VAIN.

Contribution: Zarochentseva, N.V. — participation in manuscript preparation, approval of the manuscript for publication, article reviewing after peer review; Krasnopolsky, V.I. — article reviewing after peer review, approval of the final article version; Dzhidzhikhia, L.K. — review of critically important material; Menshikova, N.S. — review of critically important material; Baranov, I.I. — review of critically important material, approval of the final article version; Rovinskaya, O.V. — participation in manuscript preparation, article reviewing after peer review; Ashrafyan, L.A. — review of critically important material, approval of the final article version; Kiselev, V.I. — approval of the manuscript for publication, approval of the final article version.

Conflict of interest: The authors declare that they do not have any conflict of interests.

Received: 20.12.2019
Accepted: 26.12.2019

N.V. Zarochentseva (Corresponding author) — Moscow Regional Scientific Centre of Obstetrics and Gynecology, Ministry of Health of Moscow Region; 22А Pokrovka Str., Moscow, Russian Federation 101000. ORCID: https://orcid.org/0000-0001-6155-788X. E-mail: ninazar11@mail.ru

V.I. Krasnopolsky — Moscow Regional Scientific Centre of Obstetrics and Gynecology, Ministry of Health of Moscow Region; 22А Pokrovka Str., Moscow, Russian Federation 101000. eLIBRARY.RU SPIN: 9537-1147. ORCID: https://orcid.org/0000-0001-7041-9024. E-mail: ninazar11@mail.ru

L.K. Dzhidzhikhia — Moscow Regional Scientific Centre of Obstetrics and Gynecology, Ministry of Health of Moscow Region; 22А Pokrovka Str., Moscow, Russian Federation 101000. eLIBRARY.RU SPIN: 1278-4233. ORCID: https://orcid.org/0000-0002-2853-0957. E-mail: lel3311@yandex.ru

N.S. Menshikova — Moscow Regional Scientific Centre of Obstetrics and Gynecology, Ministry of Health of Moscow Region; 22А Pokrovka Str., Moscow, Russian Federation 101000. eLIBRARY.RU SPIN: 9710-2930. ORCID: https://orcid.org/0000-0003-4088-6937. E-mail: Mnckmm@mail.ru

I.I. Baranov — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin Str., Moscow, Russian Federation 117997. ORCID: https://orcid.org/0000-0002-9813-2823. E-mail: i_baranov@oparina4.ru

O.V. Rovinskaya — Moscow Regional Scientific Centre of Obstetrics and Gynecology, Ministry of Health of Moscow Region; 22А Pokrovka Str., Moscow, Russian Federation 101000. ORCID: https://orcid.org/0000-0002-5191-5740. E-mail: Osya_92@mail.ru

L.A. Ashrafyan — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin Str., Moscow, Russian Federation 117997. eLIBRARY.RU SPIN: 4870-1626. E-mail: Levaa2004@yohoo.com

V.I. Kiselev — V.I. Kulakov National Medical Scientific Centre of Obstetrics, Gynecology and Perinatal Medicine of the Ministry of Health of Russia; 4 Academician Oparin Str., Moscow, Russian Federation 117997. ORCID: https://orcid.org/0000-0002-4721-3420. E-mail: vkis10@mail.ru

Table 1
Terminology of the International Federation of Cervical Pathology and Colposcopy for normal and pathological colposcopic characteristics of the vagina

t9_1.jpg

Table 2
Types of therapy for vaginal intraepithelial neoplasia

t9_2.jpg

Table 3
The effectiveness of various vaccines is relatively diseases of the vulva and vagina associated with human papillomavirus (HPV)

t9_3.jpg

Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention
4 February 16:52
LITERATURE
  1. Rogovskaya S.I., Lipova E.V., eds. Cervix, vagina, vulva: physiology, pathology, colposcopy, aesthetic correction. M.: Status Praesens; 2016: 590-6. (in Russian)
  2. Gretsova O.P., Kostin A. A., Samsonov Y.V., Petrova G.V., Prostov M.Y., Prostov Y.I. Morbidity and mortality from malignant neoplasms associated with human papillomavirus. Res. Pract. Med. J. (Moscow). 2017; 4(3): 33–50.
  3. Kaprin A.D., Starinskiy V.V., Petrova G.V., eds. Malignancies in Russia in 2017 (morbidity and mortality). M.: Herzen Scientific Research Institute, Federal Research Centre for Radiology, Ministry of Health of Russia; 2018: 41. (in Russian)
  4. Gunderson C.C., Nugent E.K., Elfrink S.H., Gold M.A., Moore K.N. A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia. Am. J. Obstet. Gynecol. 2013; 208(5): 410.e1–6. DOI: 10.1016/j.ajog.2013.01.047
  5. He Y., Zhao Q., Geng Y.N., Yang S.L., Yin C.H., Wu Y.M. Clinical analysis of cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia. Medicine (Baltimore). 2017; 96(17): e6700. DOI: 10.1097/MD.0000000000006700
  6. Cong Q., Song Y., Wang Q., Zhang H., Gao S., Sui L. A retrospective study of cytology, high-risk HPV, and colposcopy results of vaginal intraepithelial neoplasia patients. Biomed. Res. Int. 2018; 2018: 5894801. DOI: 10.1155/2018/5894801
  7. Singer A., Khan A. Pre-malignant condition in cervix, vagina, vulva: diagnosis and treatment. M.: GEOTAR-Media; 2017: 204–23. (in Russian)
  8. Shafi M.I., Nazeer S. Colposcopy. A practical guide second edition. Cambridge: Cambridge University Press; 2012: 57–62.
  9. Frega A., Sopracordevole F., Assorgi C., Lombardi D., De Sanctis V., Catalano A. et al. Vaginal intraepithelial neoplasia: a therapeutical dilemma. Anticancer Res. 2013; 33(1): 29–38.
  10. Khan M.J., Massad L.S., Kinney W., Gold M.A., Mayeaux E.J. Jr, Darragh T.M. et al. A common clinical dilemma: management of abnormal vaginal cytology and human papillomavirus test results. J. Low Genit. Tract Dis. 2016; 20(2): 119–25. DOI: 10.1097/LGT.0000000000000185
  11. Smith J.S., Backes D.M., Hoots B.E., Kurman R.J., Pimenta J.M. Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet. Gynecol. 2009; 113(4): 917–24. DOI: 10.1097/AOG.0b013e31819bd6e0
  12. De Vuyst H., Clifford G.M., Nascimento M.C., Madeleine M.M., Franceschi S. Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis. Int. J. Cancer. 2009; 124(7): 1626–36. DOI: 10.1002/ijc.24116
  13. Saraiya M., Unger E.R., Thompson T.D., Lynch C.F., Hernandez B.Y., Lyu C.W. et al. US assessment of HPV types in cancers: Implications for current and 9-valent HPV vaccines. J. Natl. Cancer Inst. 2015; 107(6): djv086. DOI: 10.1093/jnci/djv086
  14. Alemany L., Saunier M., Alvarado-Cabrero I., Quirós B., Salmeron J., Shin H.R. et al. Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldwide. Int. J. Cancer. 2015; 136(1): 98–107. DOI: 10.1002/ijc.28963
  15. Laurent J.St., Luckett R., Feldman S. HPV vaccination and the effects on rates of HPV-related cancers. Curr. Probl. Cancer. 2018; 42(5): 493–506. DOI: 10.1016/j.currproblcancer.2018.06.004
  16. Li H., Guo Y., Zhang J., Qiao J., Geng L. Risk factors for the development of vaginal intraepithelial neoplasia. Chin. Med. J. (Engl). 2012; 125(7): 1219–23.
  17. Li Z., Barron S., Hong W., Karunamurthy A., Zhao C. Surveillance for recurrent cancers and vaginal epithelial lesions in patients with invasive cervical cancer after hysterectomy. Am. J. Clin. Pathol. 2013; 140(5): 708–14. DOI: 10.1309/AJCPH4AFSZHU8EKK
  18. Zhang J., Chang X., Qi Y., Zhang Y., Zhang S. A retrospective study of 152 women with vaginal intraepithelial neoplasia. Int. J. Gynecol. Obstet. 2016; 133(1): 80–3. DOI: 10.1016/j.ijgo.2015.08.014
  19. Schockaert S., Poppe W., Arbyn M., Verguts T., Verguts J. Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study. Am. J. Obstet. Gynecol. 2008; 199(2): 113.e1–5. DOI: 10.1016/j.ajog.2008.02.026
  20. Kim M.K., Lee I.H., Lee K.H. Clinical outcomes and risk of recurrence among patients with vaginal intraepithelial neoplasia: a comprehensive analysis of 576 cases. J. Gynecol. Oncol. 2018; 29(1): e6. DOI: 10.3802/jgo.2018.29.e6
  21. Liao J.B., Jean S., Wilkinson-Ryan I., Ford A.E., Tanyi J.L., Hagemann A.R. et al. Vaginal intraepithelial neoplasia (VAIN) after radiation therapy for gynecologic malignancies: a clinically recalcitrant entity. Gynecol. Oncol. 2011; 120(1): 108–12. DOI: 10.1016/j.ygyno.2010.09.005
  22. Massad L.S., Xie X., Greenblatt R.M., Minkoff H., Sanchez-Keeland L., Watts D.H. et al. Effect of human immunodeficiency virus infection on the prevalence and incidence of vaginal intraepithelial neoplasia. Obstet. Gynecol. 2012; 119(3): 582–9. DOI: 10.1097/AOG.0b013e318244ee3d
  23. Smeltzer S., Yu X., Schmeler K., Levison J. Abnormal vaginal pap test results after hysterectomy in human immunodeficiency virus-infected women. Obstet. Gynecol. 2016; 128(1): 52–7. DOI: 10.1097/AOG.0000000000001457
  24. Bradbury M., Xercavins N., García-Jiménez A., Pérez-Benavente A., Franco-Camps S., Cabrera S. et al. Vaginal intraepithelial neoplasia: clinical presentation, management, and outcomes in relation to HIV infection status. J. Low Genit. Tract Dis. 2019; 23(1): 7–12. DOI: 10.1097/LGT.0000000000000431
  25. Hatch E.E., Herbst A.L., Hoover R.N., Noller K.L., Adam E., Kaufman R.H. et al. Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States). Cancer Causes Control. 2001; 12(9): 837–45. DOI: 10.1023/a:1012229112696
  26. Dodge J.A., Eltabbakh G.H., Mount S.L., Walker R.P., Morgan A. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecol. Oncol. 2001; 83(2): 363–9. DOI: 10.1006/gyno.2001.6401
  27. Murta E.F.C., Neves M.A. Jr, Sempionato L.R.F., Costa M.C., Maluf P.J. Vaginal intraepithelial neoplasia: clinical-therapeutic analysis of 33 cases. Arch. Gynecol. Obstet. 2005; 272(4): 261–4. DOI: 10.1007/s00404-005-0022-1
  28. Sherman J.F., Mount S.L., Evans M.F., Skelly J., Simmons-Arnold L., Eltabbakh G.H. Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus. Gynecol. Oncol. 2008; 110(3): 396–401. DOI: 10.1016/j.ygyno.2008.05.015
  29. Ratnavelu N., Patel A., Fisher A.D., Galaal K., Cross P., Naik R. High-grade vaginal intraepithelial neoplasia: can we be selective about who we treat? BJOG. 2013; 120(7): 887–93. DOI: 10.1111/1471-0528.12223
  30. Sopracordevole F., Barbero M., Clemente N., Fallani M.G., Cattani P., Agarossi A. et al. High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Eur. Rev. Med. Pharmacol. Sci. 2016; 20(5): 818–24.
  31. Frega A., French D., Piazze J., Cerekja A., Vetrano G., Moscarini M. Prediction of persistent vaginal intraepithelial neoplasia in previously hysterectomized women by high-risk HPV DNA detection. Cancer Lett. 2007; 249(2): 235–41. DOI: 10.1016/j.canlet.2006.09.003
  32. Marchetta J., Decamp F.; Prilepskaya V.N., ed. Colposcopy. Methods and diagnosis. M.: MEDpress-inform; 2014: 135–43. (in Russian)
  33. Bornstein J., Bentley J., Bösze P., Girardi F., Haefner H., Menton M. et al. 2011 Colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obs. Gynecol. 2012; 120(1): 166–72. DOI: 10.1097/AOG.0b013e318254f90c
  34. Massad L.S. Outcomes after diagnosis of vaginal intraepithelial neoplasia. J. Low Genit. Tract Dis. 2008; 12(1): 16–19. DOI: 10.1097/LGT.0b013e318074f968
  35. Bogani G., Ditto A., Martinelli F., Mosca L., Chiappa V., Rossetti D. et al. LASER treatment for women with high-grade vaginal intraepithelial neoplasia: a propensity-matched analysis on the efficacy of ablative versus excisional procedures. Lasers Surg. Med. 2018; 50(9): 933–9. DOI: 10.1002/lsm.22941
  36. Yalcin O.T., Rutherford T.J., Chambers S.K., Chambers J.T., Schwartz P.E. Vaginal intraepithelial neoplasia: treatment by carbon dioxide laser and risk factors for failure. Eur. J. Obstet. Gynecol. Reprod. Biol. 2003; 106(1): 64–8. DOI: 10.1016/s0301-2115(02)00209-9
  37. Benedet J.L., Wilson P.S., Matisic J.P. Epidermal thickness measurements in vaginal intraepithelial neoplasia: a basis for optimal CO2 laser vaporization. J. Reprod. Med. Obstet. Gynecol. 1992; 37(9): 809–12. 38. Terzakis E., Androutsopoulos G., Zygouris D., Grigoriadis C., Derdelis G., Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia. Eur. J. Gynaecol. Oncol. 2010; 31(4): 392–4.
  38. Terzakis E., Androutsopoulos G., Zygouris D., Grigoriadis C., Derdelis G., Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia. Eur. J. Gynaecol. Oncol. 2010; 31(4): 392–4.
  39. Matsuo K., Chi D.S., Walker L.T.D., Rosenshein N.B., Im D.D. Ultrasonic surgical aspiration for vaginal intraepithelial neoplasia. Int. J. Gynaecol. Obstet. 2009; 105(1): 71–3. DOI: 10.1016/j.ijgo.2008.11.040
  40. Zarochentseva N.V., Belaya Yu.M., Dzhidzhikhiya L.K. Preventive vaccination against cervical cancer and HPV-associated disorders: international and national data. Doctor.Ru. 2018; 2(146): 52–8. (in Russian)
Similar article
4 February 17:36, Obstetrics
E.Yu. Upryamova, E.V. Dulaeva, I.I. Bocharova, S.V. Novikova, A.V. Fedotova, N.V. Biryukova, T.S. Budykina
Successful Spontaneous Delivery in a patient with Fallot's Tetrad with Inhalational Sedoanalgesia with Sevoflurane (Case Study)
Doctor.Ru Gynecology Vol. 19 No. 1 (2020)
4 February 16:52, Gynecology
N.V. Zarochentseva, V.I. Krasnopolsky, L.K. Dzhidzhikhiya, N.S. Menshikova, I.I. Baranov, O.V. Rovinskaya, L.A. Ashrafyan, V.I. Kiselev
Vaginal Intraepithelial Neoplasia: Diagnostics, Treatment, and Prevention
Doctor.Ru Gynecology Vol. 19 No. 1 (2020)

Partners