Vaginal Intraepithelial Neoplasia Research Articles

Results of total vaginal hysterectomy in patients with cervical intraepithelial neoplasia

Abstract Introduction: Cervical intraepithelial neoplasia (CIN) is considered a precancerous lesion and is usually treated aggressively. Total hysterectomy is indicated in some cases and can be performed through the abdomen, vaginally, through laparoscopic surgery and robotic surgery combined with laparoscopic surgery. It is necessary to study to evaluate the effectiveness of total vaginal hysterectomy. Patients and methods: Clinical non-controlled interventional study in 32 patients with high - grade squamous intraepithelial lesions who underwent a total vaginal hysterectomy at Department of Oncology and Palliative Care at Hanoi Medical University Hospital from August 2018 to May 2021. Results: The average age in the study was 48,9 years old,mainly in the age group < 44 years old, accounting for 37,5%. The majority of patients came to the clinic because of vaginal discharge. All patients had a detailed clinical examination, gynecological ultrasound, PAP test, cervical biopsy to confirm the diagnosis before surgery. The average surgery time was 55,9±14,9 minutes, and the average volume of blood loss was 76,8 ± 23,5ml. Post-operative patients recover movement soon, the level of pain is reduced. There was none of case with intra- and postoperative complications were recorded. During the follow-up process, no vaginal intraepithelial neoplasia and abdominal lymphadenopathy recurrence was detected. Conclusion: Total vaginal hysterectomy in patients with high grade squamous intraepithelial lesion is considered as safe and feasible. Key words: Cervical intraepithelial neoplasia, total vaginal hysterectomy. Human papiloma virus.

Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis

ObjectiveTo explore the efficacy of human papillomavirus (HPV) vaccination on the risk of HPV infection and recurrent diseases related to HPV infection in individuals undergoing local surgical treatment.DesignSystematic review and...

A descriptive analysis of posttreatment retention of patients with vulvovaginal dysplasia and malignancies (505)

<b>Objectives:</b> Surveillance follow-up for women with vaginal and vulvar cancer, extrapolated by National Comprehensive Cancer Network (NCCN), includes a physical exam every 3-6 months during the first two years, followed by every 6-12 months for three to five years after treatment. For VAIN, general recommendations for follow-up suggest a physical exam every six months for the first two years and yearly after. For VIN, physical exams every six months for the first five years are recommended. Little is known regarding rates of retention for follow-up in these rare cancers and dysplasia. We sought to explore post-treatment retention for patients with vaginal and vulvar cancer and dysplasia at our institution. <b>Methods:</b> After IRB approval, we retrospectively identified patients treated for vaginal and/or vulvar intraepithelial neoplasia or carcinoma between 2011-2016. Baseline demographic, pathologic, treatment, surveillance, and recurrence data were collected. We examined the continuous and total retention of post-treatment surveillance visits for patients diagnosed with cancer VIN, VAIN, or concomitant VIN and VAIN. Continuous retention was defined as sequential visits no longer than one year apart. Descriptive statistics were used to analyze the data. <b>Results:</b> We identified 40 patients who met the criteria for review. The median age of treatment was 60 years old. Most patients were White (75%), followed by Asian (10%), Black (5%), other (8%), and American Indian (3%). The most common diagnoses were VIN III (25%), VAIN III (22%), and squamous cell carcinoma (22%). Most were treated with wide local excision (42.5%), followed by radical surgery (30%), and laser surgery (15%). The median times for total and continuous post-treatment retention were 27.5 and 21 months, respectively. The median number of visits and pap smears in the first post-treatment year were 2 and 1, respectively. The median number of visits and pap smears in the second post-treatment year were 1 and 1, respectively. Only 29% of patients continued with surveillance in the third post-treatment year. Recurrence was noted in ten patients (25%) with a median time of recurrence of 29 months with a range of 1-69 months. The most common primary diagnoses associated with recurrence were VIN III (40%), VAIN III (20%), VIN II (20%), and squamous cell carcinoma (20%). <b>Conclusions:</b> This is the first baseline assessment of post-treatment surveillance retention for VAIN, VIN, or vulvovaginal carcinoma. We observed that our population generally adheres to NCCN surveillance guidelines during the first year; however, the adherence drops in the following years with a median continuous retention rate of less than two years. Further work is needed to enhance post-treatment surveillance and identify barriers to follow-up for patients.

Evaluation of 5-aminolevulinic acid-mediated photodynamic therapy in postmenopausal women with persistent HPV infection with or without cervical and vaginal low-grade squamous intraepithelial lesions (CIN1/VaIN1)

ObjectiveTo analyze the efficacy and safety of photodynamic therapy (PDT) on postmenopausal women with persistent human papillomavirus (HPV) infection with or without low-grade cervical and vaginal intraepithelial neoplasia (CIN1 and VaIN1). Materials and methodsThe clinicopathological and follow-up data of 86 postmenopausal women with HPV infection (35 cases with chronic cervicitis and 51 cases with CIN1/VaIN1) were collected. All the women in this group met these criteria: menopausal time ≥ 1 year, HPV infection time ≥ 2 years, colposcopy and pathological diagnosis of biopsy ≤ CIN1/VaIN1 before PDT treatment, and 5-aminolaevulinic acid (5-ALA) as photosensitizer treating for 6 times with a week interval. The above patients were followed up 6 months and 12 months after PDT treatment, and the follow-up contents included HPV typing, cytology, colposcopy and pathological examinations. HPV negative conversion rate and lesion remission rate are the evaluation indicators of treatment efficacy. In addition, we also assessed the safety of PDT treatment. ResultsAt 12-month follow-up, the overall HPV clearance rate was 60% (45/75), of which the negative conversion rate of 16/18 HPV was 41.38% (12/29), and non-16/18 HPV was 71.74% (33/46) (p = 0.009). In patients without lesions, the HPV clearance rate was 51.72% (15/29), while in patients with CIN1/VaIN1 (n = 46), the HPV complete remission rate and lesion regression rate were 65.22% (30/46) and 89.13% (41/46), respectively. In addition, the clearance rate of HPV in lesion regression group was significantly higher than that in lesion persistence/progression group (0.00% vs. 73.17%, p = 0.003). The adverse reactions after PDT treatment were mild, mainly manifested as increased vaginal secretions or burning/tingling. ConclusionsPhotodynamic therapy can significantly enhance the elimination rate of persistent HPV infection in postmenopausal women and reduce the progression of CIN1/VaIN1. It could be an effective conservative treatment for persistent HPV infection and CIN1/VaIN1 in postmenopausal women.

Comparative study of topical 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) and surgery for the treatment of high-grade vaginal intraepithelial neoplasia

ObjectiveTo compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and local surgical excision in the treatment of high-grade vaginal intraepithelial neoplasia (VAIN). MethodsThis was a retrospective study of a single center. Patients with biopsy-proven high-grade VAIN were counseled on the option of excision or ALA-PDT. After treatment patients were followed up at 3, 6 and 12 months and every 6 months afterwards. Clinical data of two groups were analyzed. ResultsSixty patients were treated with ALA-PDT and 40 patients underwent excision surgery. The clinical characteristics of patients in the two groups were similar. The mean ages of patients treated with ALA-PDT and local surgical excision were 41.93+13.08 (18-70) and 43.25+11.64 (22–61) years old, respectively. The treatment times of PDT for patients in the ALA-PDT group were 5.48±1.41 (2-8) times. At 3–6 months after treatment, the overall complete remission (CR) rate was 93.33% (56/60) in PDT group and 82.5% (33/40) in local surgical excision group. In PDT group, a 12- and 24-month follow-up, the total HPV clearance rate was 68.97% and 77.55%, respectively. At 12-month and 2-year follow-up after local surgical excision, the total HPV clearance rate was 60% and 64.52%, respectively. Further analysis showed that the clinical efficacy was comparable between the two treatments. Patients over 45 years old exhibited a lower HPV clearance rate (P<0.05) than those under 45 years old. It was also observed that persistent HPV infection is a major risk factor for persistent disease. Further comparative analyses showed no significant difference in the CR rate and treatment times between VAINII and VAINIII in ALA-PDT group. Moreover, 4 patients (11.36%) developed recurrent lesions during follow-up after ALA-PDT, whereas 3 patients (8.33%) in the local excision group developed recurrent lesions. In addition, there was no significant difference in the recurrent rate between two groups. ConclusionsALA-PDT shows similar efficacy and less side effects compared to local surgical excision.

Efficacy and safety of photodynamic therapy mediatied by 5-aminolevulinic acid for the treatment of vaginal high-grade intraepithelial lesions

BackgroundVaginal high-grade squamous intraepithelial lesion (HSIL) (vaginal intraepithelial neoplasia [VAIN] grade 2–3) is clinically, a precancerous lesion condition with an estimated progression rate of 10%–20%. Therefore, treatment is recommended. Because traditional treatments have limited effects, high expense and complications, here we evaluated the efficacy and safety of topical 5-aminolevulinic acid (ALA)–based photodynamic therapy (PDT). MethodsThis study consisted of 56 female patients diagnosed with vaginal HSIL. A 20% 5-ALA jelly formation was topically applied to the vaginal wall, followed by 635 nm PDT at 7–14 days intervals. Cytology, human papillomavirus (HPV) genotyping, colposcopy, and pathology were assessed after treatment. ResultsAmong the 56 patients in our study, 47 (83.9%) had VAIN 2 and 9 (16.1%) had VAIN 3. 35 patients underwent three courses of PDT treatment, 19 experienced six courses, and two experienced nine courses. The total pathological regression rate was 87.5%, and the HPV clearance rate during the 6-month follow-up was 41.9%. Lesions located in the vaginal stump after hysterectomy seem to be difficult to treat. 9%(4/44) and 23%(7/30) patients had recurrent disease during the 6-month and 1-year follow-up time point. The most common adverse event was increased vaginal discharge, other side effects include abdominal pain, vulvar pruritus, and vaginal bleeding. No severe adverse effect was observed during the treatment. ConclusionPhotodynamic therapy mediatied by 5-aminolevulinic acid is an effective and safe treatment for vaginal HSIL with minimal side effects.

Vaginal Intraepithelial Neoplasia (VaIN): Diagnosis and Management

Vaginal Intraepithelial Neoplasia (VaIN): Diagnosis and Management

Vaginal Intraepithelial Neoplasia (VaIN): Diagnosis and Management

Vaginal Intraepithelial Neoplasia (VaIN): Diagnosis and Management

Prevalance of abnormal vault cytology after hysterectomy for cervical intraepithelial neoplasia, Pietermaritzburg.

BackgroundA simple hysterectomy is considered the definitive treatment modality for cervical intraepithelial neoplasia (CIN). However, it is associated with recurrence of vaginal intraepithelial neoplasia (VAIN) of up to 7.4%. We sought to determine recurrence rates of VAIN, in women living with HIV (WLWH) and non-infected women.MethodsThis was a descriptive retrospective review of patients who received a simple hysterectomy for CIN between January 2015 and December 2017 in Pietermaritzburg.ResultsFifty-eight files were reviewed. Forty-two (72.4%) WLWH were seen; amongst those, 76.2% were virally suppressed. Abnormal vault cytology was only seen in patients with CIN grades 2 and 3. The recurrence rates for high-grade squamous intraepithelial lesion (HSIL) were 6.1% and 5.0% at 6 and 12 months, respectively. Human immunodeficiency virus co-infection was associated with 26.2% versus 13.3% of abnormal vault cytology compared to the HIV-negative counterparts (p = 0.164). Virologically suppressed patients had more abnormal cytology (28.1% vs. 0%) compared to the unsuppressed patients. There was a 17.2% and 65.5% loss- to follow-up rates at 6 and 12 months, respectively. Recurrence of premalignant lesions was noted amongst those who had the abdominal approach.ConclusionThe recurrence rates were comparable to the previous literature. A 6-month cytology follow-up showed no added benefit. Human immunodeficiency virus co-infection didn’t show a statistical significance on the recurrence rates; however, more structured studies are required to address this. Primary health care-based post operative surveillance can be a solution to address high loss to follow-up.

The eight-year long-term follow-up on the effectiveness of the quadrivalent human papillomavirus vaccine in Chinese women 20-45 years of age

ABSTRACT The quadrivalent human papillomavirus (4vHPV) vaccine has shown confirmative effectiveness in preventing HPV-related diseases among women and men around the globe. The phase III, randomized, double-blind efficacy study (Base study, NCT00834106) conducted in China showed 100% efficacy against HPV 16/18-related cervical intraepithelial neoplasia and efficacy against HPV persistent infection for 78 months. Participants aged 20–45 years who received three doses of 4vHPV vaccine or placebo during the base study were selected and invited for this long-term follow-up (LTFU) study to assess the long-term effectiveness of the 4vHPV vaccine in preventing HPV-related diseases. A total of 368 participants were included in this LTFU study with a median follow-up of 94 months. Among 27 participants (Vaccine vs. Placebo: 8 vs. 19) who underwent colposcopy and biopsy due to cervical cytological abnormalities or HPV infection, no HPV-16/18-related cases of cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), or vaginal intraepithelial neoplasia (VaIN) was observed in the vaccine group while two HPV-16-related cases (CIN1/VaIN) were observed in the placebo group. There were another two HPV-related cases (non-vaccine HPV types) found in the placebo group. Consistent with the findings from global studies that suggested long-term efficacy of 4vHPV vaccine, our study showed continued protective effect of 4vHPV vaccine against HPV-related precancerous diseases through a median follow-up time of 94 months with the longest follow-up time of 125 months after completing three doses of vaccination among Chinese women 20–45 years of age.

Precise Measurement of the Thickness of Vaginal Intraepithelial Neoplasia.

ObjectivesAlthough carbon dioxide laser vaporization is frequently used for treating vaginal intraepithelial neoplasia (VaIN), the optimal depth of epithelial destruction with laser vaporization requires elucidation. We aimed to evaluate VaIN depth and better illustrate epithelial destruction during laser vaporization.Materials and MethodsWe included 246 women diagnosed with VaIN (low-grade VaIN [VaIN 1], 123 women; high-grade VaIN [VaIN 2/3], 123 women) using colposcopy-directed biopsy at our hospital from January 1, 2019, to April 30, 2020. The thickness of the noninvolved epithelium, if available, was determined. All available data, including cytology and histological information, were recorded. The t test and Pearson χ2 test were used for statistical analysis. Statistical significance was set at p < .05.ResultsThe involved epithelial thicknesses in VaIN 2/3 and VaIN 1 were 0.41 ± 0.21 and 0.40 ± 0.19 mm, respectively, which were both greater than their noninvolved epithelial thickness values (0.17 ± 0.10 and 0.17 ± 0.08 mm, p < .01 and p < .01, respectively). In subgroup comparisons between the VaIN 2/3 and VaIN 1 groups, the involved epithelial thickness did not differ between premenopausal patients, postmenopausal women receiving estrogen, and postmenopausal women who did not receive estrogen (p > .05). In the VaIN 2/3 group, the lesion thickness in premenopausal was greater than that in postmenopausal women receiving estrogen (p = .016) and those who were not receiving estrogen (p = .017).ConclusionsThe thickness of VaIN is generally less than 1 mm for women of all ages, except in rare cases of visible lesions with papillary hyperplasia.

Risk Factor and Treatment of Vaginal Intraepithelial Neoplasia After Hysterectomy for Cervical Intraepithelial Neoplasia.

ObjectivesThe aim of the study were to identify the risk factors for recurrent vaginal intraepithelial neoplasia (VaIN)1+ and to evaluate the efficacy of laser vaporization in patients who underwent hysterectomy for the treatment of cervical intraepithelial neoplasia (CIN).MethodsMedical records of 374 women who underwent hysterectomy for the treatment of CIN were retrospectively reviewed. Recurrence was defined as VaIN1+ diagnosis by colposcopy-directed biopsy.ResultsAmong 374 patients, 36 (9.6%) had VaIN1+ during a median follow-up of 32 (0–193) months: 13 (3.5%) had VaIN1, 6 (1.6%) VaIN2, 15 (4.0%) VaIN3, and 2 (0.5%) invasive cancer. Multivariate analysis showed that age of greater than 50 years was the only independent risk factor for VaIN1+ recurrence (odds ratio, 3.359; 95% CI, 1.60–7.07; p = .001). Among the 34 patients with VaIN, 21 (61.8%) were treated with laser vaporization and 11 (32.3%) were observed without treatment. Time to second recurrence was longer in the VaIN treated by laser vaporization group than that in the observation group (mean time to subsequent recurrence, 128.7 [95% CI, 101.4–156.0] vs. 41.8 [15.7–67.9] months; p = .003). Moreover, laser vaporization (hazard ratio, 0.125; 95% CI, 0.03–0.59; p = .009) was the only independent good prognostic factor for the second VaIN1+ recurrence.ConclusionsPatients older than 50 years who underwent hysterectomy for the treatment of CIN might be highly at risk of VaIN1+. Laser vaporization is the only independent prognostic factor that might prevent the second VaIN1+ recurrence.

The effect of local photodynamic therapy with 5-aminolevulinic acid in the treatment of vaginal intraepithelial lesions with high-risk HPV infection

BackgroundRecent data has shown increased rate of vaginal intraepithelial neoplasia (VAIN) in younger individuals. Traditional VAIN treatments exert adverse effects on the anatomy and functions of the vagina. Topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a novel, non-invasive targeted therapy for intraepithelial lesions. Here, we aimed to investigate the efficacy and safety of ALA-PDT in VAIN with high-risk HPV (HR-HPV) infection. MethodsThis study enrolled a total of 82 HR-HPV-positive women diagnosed with VAIN, who were receiving ALA-PDT. The effect of ALA-PDT was evaluated using HPV genotyping and Thinprep cytologic test (TCT). Besides, colposcopy directed biopsies were performed in all patients at 3-month follow-up, and in patients with positive HR-HPV and/or abnormal TCT results during the follow-up period. ResultsOur data showed that the HPV clearance rate was 53.7% (44/82) at 6-month follow-up and 67.1% (55/82) at 12-month follow-up. Patients with HPV16/18 combined with other HR-HPV (HPV16/18 & other HR-HPV) infection, those with a history of hysterectomy and/or older age were had significantly lower HPV clearance rate. Besides, the lesion complete remission (CR) rate was 90.2% (74/82). These results show that HPV16/18 & other HR-HPV infection was associated with significantly lower CR rates. Throughout the follow-up, 2 cases had persistent lesions (2.4%), 6 cases had partial remission (7.3%), 2 cases recurred (2.7%) but none of the patients had disease progression. ConclusionsTaken together, our data showed that ALA-PDT is an effective, safe, and alternative treatment for VAIN patients with HR-HPV infection. However, the ALA-PDT efficacy was relatively poor in patients with older age, HPV16/18 & other HR-HPV infection and/or those with a history of hysterectomy.

Analysis of related factors of cervical intraepithelial neoplasia complicated with vaginal intraepithelial neoplasia.

To explore the underlying risk factors and to prevent misdiagnosis of cervical intraepithelial neoplasia (CIN) coexisted with vaginal intraepithelial neoplasia (VaIN). Clinical data of patients pathologically diagnosed with CIN were collected from January 2017 to December 2018. A total of 446 cases were analyzed, including 406 cases of single lesions ('CIN single' group) and 40 cases complicated with VAIN ('VAIN concurrent' group). The median age of the VAIN concurrent group was 53years (46.25-59years), and the median age of the CIN single group was 44years (36-50years). Regarding menopausal status, there were 28 cases (70.0%) in the VAIN concurrent group and 89 cases (21.9%) in the CIN single group (P < 0.005). The median load of high-risk human papillomavirus (Hr-HPV) in the VAIN concurrent and CIN single group was 923.4 relative light units/cutoff (RLU/CO) (145-2172.2 RLU/CO) and 229.155 RLU/CO (18.615-638.1275 RLU/CO), respectively (P = 0.037). The results revealed that the menopausal status was an independent risk factor for VAIN occurrence in CIN patients. The risk of VAIN in menopausal patients was higher than that in non-menopausal CIN patients (OR = 8.311, 95% CI 4.062-17.005). Age and HPV load were also related to the concurrence of VAIN and CIN. Examinations regarding vaginal screening are of great importance in the diagnosis of perimenopausal and postmenopausal CIN patients, especially patients with Hr-HPV load. Colposcopy and tissue biopsy should also be performed, when necessary, to avoid misdiagnosis and the appearance of vaginal lesions.

A retrospective study of 657 women with vaginal intraepithelial neoplasia (VaIN)

Vaginal intraepithelial neoplasia (VaIN) is frequently underdiagnosed. The aim of this study was to explore the clinical characteristics of patients with VaIN and identify more sensitive diagnostic methods. This study retrospectively analyzed 657 patients with VaIN from the International Peace Maternal and Child Health Hospital during a ten-year period. Among the 657 patients, 26.5% were diagnosed with VaIN 2/3. The proportions of patients with VaIN 2/3 among those who did and did not undergo hysterectomy were 39.5% and 24.7%, respectively. The sensitivity of cytology testing for VaIN in those with only VaIN, VaIN concomitant with cervical or vulvar lesions, and posthysterectomy VaIN was 56.7%, 66.5%, and 72.3%, respectively. The sensitivity of high-risk human papillomavirus (hrHPV) testing for VaIN in the same categories was 87.7%, 86.5%, and 74.3%, respectively. The sensitivity of cytology and hrHPV cotesting for VaIN in the same categories was 95.2%, 95.6%, and 95.0%, respectively. In patients with VaIN 2/3, the incidence of HPV 16/18 was 50.6%. However, in patients with VaIN 1, the incidence of HPV 16/18 was only 22.6 %. The severity of VaIN was associated with HPV genotyping and hysterectomy, but not with concomitant cervical or vulvar lesions. A combination of cytology and hrHPV could increase the sensitivity of the diagnosis of VaIN. HPV 16 and 18 are the most frequent HPV-types in VaIN 2/3. Twelve specific hrHPV subtypes were the main virus types associated with the development of VaIN 1.

Comparison of the safety between cervical conization and hysterectomy for patients with cervical adenocarcinoma in situ.

To compare the safety between cervical conization (CC) alone and hysterectomy for patients with adenocarcinoma in situ (AIS) of the cervix. Patients diagnosed with AIS after CC during 2007-2021 were identified by computerized databases at Women's Hospital of Zhejiang University School of Medicine. A total of 453 AIS patients were divided into 2 groups according to uterus preservation: hysterectomy group (n=300) and CC(s) alone group (n=153). The prevalence of residual disease and disease recurrence was compared between patients treated by CC(s) alone and hysterectomy. The prevalence of residual disease in specimens from women who had a hysterectomy and repeat CC were compared between positive and negative margins of CC. The factors influencing residual disease and disease recurrence were assessed. Among 310 specimens from women who had a hysterectomy or repeat CC, the prevalence of residual disease was 50.6% (45/89) for a positive margin and 2.3% (5/221) for a negative margin (p=0.000). Four patients had recurrence of vaginal intraepithelial neoplasia in those treated by hysterectomy and one had recurrence of cervical squamous intraepithelial neoplasia in those treated by CC(s) alone. The prevalence of recurrence was 0.7% (1/153) for CC(s) alone and 1.3% (4/300) for hysterectomy (p=0.431). Hysterectomy did not influence residual disease or disease recurrence. CC is an efficacious and safe option for patients with AIS of the cervix provided the margin is negative.

A Prospective Study of Multiple Targeting CO &lt;sub&gt;2&lt;/sub&gt; Laser Ablation for the Treatment of Vaginal Intraepithelial Neoplasia

A Prospective Study of Multiple Targeting CO &lt;sub&gt;2&lt;/sub&gt; Laser Ablation for the Treatment of Vaginal Intraepithelial Neoplasia

Effect and rational application of topical photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) for treatment of cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia

BackgroundLesions in both the cervix and vagina require an efficacious non-invasive treatment therapy such as 5-Aminolevulinic acid photodynamic therapy(5-ALA-PDT). In this study, we evaluate clinical efficacy and safety of 5-ALA PDT for cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia (CIN & VAIN). MethodsA retrospective analysis was performed on 48 patients diagnosed with CIN & VAIN and receiving 5-ALA PDT. All patients were first followed up at 3, 6 and 12 months after treatment, then every 6 months thereafter. ResultsOut of 1051 patients referred for CIN (4.56%), 48 were diagnosed with CIN&VAIIN. The patients had statistically significant average vaginal and cervical lesion areas of 1.22 and 0.41 cm2 respectively. 4 patients were lost during follow-up. The patients’ complete remission (CR) rate was 88.64% (39/44) at 3–6 months after treatment, while the total HPV clearance rate was 46.34 and 60.98% at 3- and 12-months follow-up,respectively. HPV16/18 combined with other high-risk human papillomaviruses (hrHPV) (HPV16/18 and other hrHPV) infection exhibited a lower HPV clearance rate (P = 0.006). The treatment time in high-grade intraepithelial neoplasia (HSIL) was higher than that of low-grade intraepithelial neoplasia (LSIL). Notably, atypical vessels and endocervical canal lesions involvement significantly affected 5-ALA PDT. Moreover, 5 patients had residual lesions (11.36%) during follow-up, one patient presented recurrence (2.56%), while 4 had successful pregnancy. Conclusions5-ALA-PDT is a non-invasive, effective, and safe therapy for treating CIN & VAIN and can maintain the structural and functional integrity of target organs. However, its efficacy is relatively poor in patients with endocervical canal lesions involvement, atypical vessels, and HPV16/18 and other hrHPV infection.

Clinical characteristics of single human papillomavirus 53 infection: a retrospective study of 419 cases

BackgroundHuman papillomavirus (HPV) infection is the main cause of cervical cancer. Characteristics of HPV infections, including the HPV genotype and duration of infection, determine a patient’s risk of high-grade lesions. Risk quantification of cervical lesions caused by different HPV genotypes is an important component of evaluation of cervical lesion. Data and evidence are necessary to gain a deeper understanding of the pathogenicity of different HPV genotypes. The present study investigated the clinical characteristics of patients infected with single human papillomavirus (HPV) 53.MethodsThis retrospective study analyzed the clinical data of patients who underwent cervical colposcopy guided biopsy between October 2015 and January 2021. The clinical outcomes and the follow-up results of the patients with single HPV53 infection were described.Results82.3% of the initial histological results of all 419 patients with single HPV53 infection showed negative (Neg). The number of patients with cervical intraepithelial neoplasia (CIN)1, CIN2, CIN3, vaginal intraepithelial neoplasia (VaIN)1, CIN1 + VaIN1, CIN1 + VaIN2, and CIN2 + VaIN2 was 45, 10, 2, 9, 6, 1, and 1, respectively. Cancer was not detected in any patient. When the cytology was negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL), we observed a significant difference in the distribution of histological results (P < 0.05). 95 patients underwent follow-up with cytology according to the exclusion criteria. No progression of high-grade lesions was observed during the follow-up period of 3–34 months.ConclusionsThe lesion caused by HPV53 infection progressed slowly. The pathogenicity of a single HPV53 infection was low.

Screening History in Vaginal Precancer and Cancer: A Retrospective Study of 2131 Cases in China.

PurposeTo examine the screening history of vaginal intraepithelial neoplasia (VaIN) and vaginal cancer.Patients and MethodsWe included women with histologically confirmed VaIN or vaginal cancer by colposcopy-directed biopsy between 1 January 2019 and 31 December 2019. The results of cytology, hrHPV, colposcopic examination and history of hysterectomy were retrospectively analysed.ResultsA total of 26,432 colposcopies were performed during the study period, among which 2131 women (1835 [86.1%] with VaIN 1; 268 [12.6%] with VaIN 2/3; and 28 [1.3%] with vaginal cancer) were retrospectively studied. hrHPV test positivity was significantly higher than that of cytology for VaIN 1 (84.4% vs 67.3%; P < 0.001) and VaIN 2/3 (92.0% vs 79.9%; P < 0.001) but not for vaginal cancer (84.6% vs 78.6%; P = 0.73). Additionally, the concordance rates for colposcopic impression were 79.5%, 54.5%, and 92.8% for VaIN1, VaIN2/3, and vaginal cancer, respectively. All 372 patients had a history of hysterectomy, and 81.0% (282/348) of indications were related to cervical precancer and cancer. Although cytology test positivity was significantly higher in patients with hysterectomy than in patients without hysterectomy (76.2% vs 67.5%; P < 0.001), cytology combined with hrHPV can help to detect more than 95% of VaIN and vaginal cancer cases in both groups (96.2% for patients with hysterectomy and 96.5% for patients without hysterectomy).ConclusionVaIN and vaginal cancer are not rare diseases. Although cytology was sensitive (67.5%–76.2%) for detecting vaginal lesions regardless of hysterectomy, cytology combined with hrHPV improves detection accuracy up to 95% in both groups.