The management and follow-up of patients with high-grade cervical glandular intraepithelial neoplasia

ObjectivesSuperficially invasive stage IA squamous vulvar cancer (VSCC) is defined as a single lesion measuring ≤2 cm with a depth of invasion of ≤1.0 mm (FIGO stage IA). This article examines the natural course and prognosis of superficially invasive VSCC.MethodsThis is a retrospective case series of 46 patients (median age 58 years) with superficially invasive stage IA VSCC receiving wide local excision between January 1996 and November 2014 in the University Medical Center Hamburg-Eppendorf.ResultsMedian tumor size was 4 mm. In 39/46 (84.8%) patients peri-tumoral high-grade intraepithelial neoplasia (HSIL) and/or lichen sclerosus (LS) of the vulva were histologically detected: 34 (74.0%) usual type high-grade vulvar intraepithelial neoplasia (uVIN, HSIL), 4 (8.7%) LS with simultaneous VIN (3 uVIN, 1 differentiated VIN (dVIN)), 1 (2.2%) with LS only. 37/46 (80.4%) patients had a R0 resection; in 2 (4.3%) a high-grade VIN was detected in the margin and in 7 (15.2%) the resection status was unknown. The mean follow-up was 58 (range 10–185) months. Four patients (8.7%) suffered from an invasive recurrence after 4, 17, 40, and 54 months, three in the vulva and one in the groin. All local recurrences occurred in women with LS in a combination with high-grade VIN (3 uVIN, 1 dVIN). Two were treated surgically again including inguino-femoral lymphadenectomy (ifLAE) (no regional lymph node metastasis histologically) as invasion depth exceeded 1 mm. The third patient refused treatment. Inguinal recurrence was treated with a bilateral ifLAE, revealing one positive lymph node, followed by adjuvant radiotherapy (groins, pelvis). None of these patients had experienced further recurrences at last follow-up.ConclusionsSuperficially invasive VSCC is characterized by having a very good prognosis. Sole surgical therapy is highly effective. Patients with LS might benefit additionally from intensified surveillance and adequate maintenance therapy in specialized centers.

Download Full-text

Human papilloma virus testing in patient follow-up post cone biopsy due to high-grade cervical intraepithelial neoplasia

Gynecologic Oncology ◽

10.1016/s0090-8258(02)00137-3 ◽

2003 ◽

Vol 88 (3) ◽

pp. 345-350 ◽

Cited By ~ 17

Author(s):

Benny Almog ◽

Ronni Gamzu ◽

Michael J Kuperminc ◽

Ishai Levin ◽

Ofer Fainaru ◽

...

Keyword(s):

Human Papilloma Virus ◽

Cervical Intraepithelial Neoplasia ◽

Intraepithelial Neoplasia ◽

High Grade ◽

Papilloma Virus ◽

Cone Biopsy ◽

Virus Testing

Download Full-text

Providing high quality information about human papillomavirus for women after treatment for high-grade cervical dysplasia

Sexual Health ◽

10.1071/sh09059 ◽

2010 ◽

Vol 7 (1) ◽

pp. 49 ◽

Cited By ~ 4

Author(s):

Suzanne Dyson ◽

Marian Pitts ◽

Anthony Lyons ◽

Robyn Mullins

Keyword(s):

Human Papillomavirus ◽

Information Needs ◽

Qualitative Interviews ◽

Cervical Dysplasia ◽

Pap Test ◽

Intraepithelial Neoplasia ◽

General Information ◽

High Grade ◽

Hpv Testing

Background: The present study aimed to inform the production of a resource for women who have had a high-grade cervical abnormality and are scheduled to undergo testing for human papillomavirus (HPV) at their 12-month follow-up. Methods: Two rounds of semi-structured, qualitative interviews were held with women who were attending a gynaecological oncology clinic at a major teaching hospital for women in Melbourne, Australia, 6 months after treatment for cervical intraepithelial neoplasia (CIN) to receive a follow-up Pap test and colposcopy. In an initial round of interviews, we gauged the reactions of 16 women to an existing information brochure containing general information about HPV. Based on the findings from the interviews, a second brochure aimed specifically for women scheduled to undergo HPV testing as part of their post treatment follow-up was drafted. Feedback was then gathered from a further 12 women. Results: While all participants had received some information and counselling about HPV and HPV testing as part of their treatment, many still experienced high levels of stress and anxiety about cancer and the sexually transmissible nature of HPV. Many also still had unanswered questions about HPV, their treatment regime and future prognosis. Conclusion: For a brochure to provide an effective adjunct to counselling, it is essential that it is carefully developed and pilot tested to ensure that it is easily understood and meets the information needs of the target audience. Such materials need to provide both medical and psychosocial information about HPV and be presented in accessible, easy to understand language.

Download Full-text

Role of Colposcopy after Treatment for Cervical Intraepithelial Neoplasia

Cancers ◽

10.3390/cancers12061683 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1683

Author(s):

Annu Heinonen ◽

Maija Jakobsson ◽

Mari Kiviharju ◽

Seppo Virtanen ◽

Karoliina Aro ◽

...

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Local Treatment ◽

Intraepithelial Neoplasia ◽

Margin Status ◽

High Grade ◽

Large Loop ◽

Glandular Cells ◽

Low Sensitivity

Colposcopy is often used in follow-up after treatment for cervical intraepithelial neoplasia (CIN) despite its marked inter-observer variability and low sensitivity. Our objective was to assess the role of colposcopy in post-treatment follow-up in comparison to hrHPV (high-risk human papillomavirus) testing, cytology, and cone margin status. Altogether, 419 women treated for histological high-grade lesion (HSIL) with large loop excision of the transformation zone (LLETZ) attended colposcopy with cytology and hrHPV test at six months. Follow-up for recurrence of HSIL continued for 24 months. Colposcopy was considered positive if colposcopic impression was recorded as high grade and cytology if HSIL, ASC-H (atypical squamous cells, cannot exclude HSIL), or AGC-FN (atypical glandular cells, favor neoplasia) were present. Overall, 10 (10/419, 2.4%) recurrent HSIL cases were detected, 5 at 6 months and 5 at 12 months. Colposcopic impression was recorded at 407/419 6-month visits and was positive for 11/407 (2.7%). None of them had recurrent lesions, resulting in 0% sensitivity and 97% specificity for colposcopy. Sensitivity for the hrHPV test at 6 months was 100% and specificity 85%, for cytology 40% and 99%, and for margin status at treatment 60% and 82%, respectively. While the hrHPV test is highly sensitive in predicting recurrence after local treatment for CIN, colposcopy in an unselected population is not useful in follow-up after treatment of CIN.

Download Full-text

Human Papillomavirus Detection by Hybrid Capture II and Residual or Recurrent High-Grade Squamous Cervical Intraepithelial Neoplasia after Large Loop Excision of the Transformation Zone (LLETZ)

Tumori Journal ◽

10.1177/030089160509100216 ◽

2005 ◽

Vol 91 (2) ◽

pp. 188-192 ◽

Cited By ~ 8

Author(s):

Luís Otávio Sarian ◽

Sophie Françoise Mauricette Derchain ◽

Denise da Rocha Pitta ◽

Liliana Aparecida Angelo Andrade ◽

Sirlei Siani Moráis ◽

...

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Dna Detection ◽

Intraepithelial Neoplasia ◽

High Grade ◽

Transformation Zone ◽

Hybrid Capture ◽

Hpv Dna ◽

Large Loop ◽

Gynecological Examination

Aims and background The purpose of this study was to assess the association between highly-oncogenic types HPV DNA detection by Hybrid Capture II (HCII) and residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2 or 3) during the follow-up of women submitted to large loop excision of the transformation zone (LLETZ). Study design In this cohort study, 94 women submitted to LLETZ because of CIN 2 or 3 between March 2001 and September 2002 were followed up twice yearly until September 2003. Follow-up visits consisted of an interview regarding clinical, social and demographic characteristics complemented with gynecological examination with specimen collection for Pap test and HCII and colposcopy. Eighty-one patients attended the first visit (mean 4.8 months, range 3-6) and 75 the second visit (mean 10.9 months, range 7-17 months). McNemar's test to assess the variation of HPV DNA detection following LLETZ, odds ratios (OR) to evaluate the correlation between HPV DNA positivity and residual/recurrent CIN during follow-up, and logistic regression to assess the risk of residual/recurrent CIN were used. Results There was a strong and significant reduction in HPV detection after LLETZ ( P <0.001). HPV DNA detection was correlated with residual/recurrent CIN at the first (OR = 103.4; 95% CI 5.5 to 1961.2) and second (OR = 12.7; 95% CI 1.1 to 345.5) follow-up visits. Multivariate analysis showed HPV persistence as a stand-alone risk factor for residual/recurrent CIN (OR = 50.3; 95% CI 3.8 to 663.1). Conclusions High risk HPV DNA detection decreased substantially after CIN treatment with LLETZ, but HPV persistence was strongly correlated with residual/recurrent CIN.

Download Full-text

403 LONG-TERM FOLLOW-UP OF HIGH-GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA AND ATYPICAL FOCI SUSPICIOUS FOR CARCINOMA ON SEXTANT PROSTATE NEEDLE BIOPSY

European Urology Supplements ◽

10.1016/s1569-9056(07)60401-1 ◽

2007 ◽

Vol 6 (2) ◽

pp. 123

Author(s):

T. Wolters ◽

M. Roobol ◽

S. Roemeling ◽

C. Gosselaar ◽

F. Schröder ◽

...

Keyword(s):

Needle Biopsy ◽

Intraepithelial Neoplasia ◽

Prostatic Intraepithelial Neoplasia ◽

High Grade ◽

Prostate Needle Biopsy ◽

Long Term Follow Up

Download Full-text

Development of invasive disease in 433 women treated for vulvar, vaginal or perianal intraepithelial neoplasia

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5043 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5043-5043

Author(s):

M. K. Fehr ◽

K. J. Dedes ◽

S. Heinzl ◽

M. D. Mueller ◽

M. Baumann ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Case Series ◽

Intraepithelial Neoplasia ◽

Invasive Disease ◽

Malignant Potential ◽

Initial Diagnosis ◽

Laser Evaporation ◽

High Grade

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.

Download Full-text