High‐grade vaginal intraepithelial neoplasia: can we be selective about who we treat?

ObjectiveTo determine the role of conservative management in high‐grade vaginal intraepithelial neoplasia (HG VaIN).DesignRetrospective observational study.SettingNorthern Gynaecological Oncology Centre, Gateshead, UK.PopulationA total of 100 women with histologically‐proven HG VaIN.MethodsReview of patient records from 1995 to 2011.Main outcome measuresRates of progression to cancer, treatment remission, and disease recurrence, particularly post‐treatment when vaginoscopy is normal but cytology is abnormal.ResultsOf 100 women referred, 69 underwent initial treatment of whom 47 (68%) went into remission: of these, seven developed a recurrence after a median follow‐up of 29 months (range 15–214 months). Of the 31 women managed conservatively with cytological and vaginoscopic surveillance, no cancers developed after a median follow‐up of 35 months (range 2–230 months). Rate of overall progression to cancer was 3% and all were detected among the initial treatment group after a median of 59 months (range 8–249 months). Post‐treatment, when normal vaginoscopy was accompanied by abnormal cytology, two categories existed. Of 24 cases with low‐grade cytological abnormality, recurrence of HG VaIN occurred in seven (29%) after a median follow‐up of 12 months (range 2–110 months). Of 19 cases with HG cytological abnormality, 15 (79%) developed recurrence at a median follow‐up of 7 months (range 2–21 months), giving a hazard ratio 5.6 (95% confidence interval 2.0–15.5, P = 0.001).ConclusionsIt is possible to select women with HG VaIN for conservative surveillance with excellent results. The majority of women undergoing initial treatment will enter remission. Post‐treatment, if cytological abnormality develops in the presence of normal vaginoscopy, the majority of women will develop histological HG VaIN recurrence.