Organ-preserving laser surgery of vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VAIN)) - Chances and limitations

Chances and limitations: To underline the possibilities and limitations of organ-preserving laser surgery in vulvar intraepithelial neoplasia (VIN) and vaginal intraepithelial neoplasia (VaIN), we report on a study running since 1993 in the Department of Gynaecology of the University of Heidelberg. 12 patients with VIN II and III had organ preserving laser surgery, The observation interval was at least 1 year after therapy. All patients underwent a standardised preoperative and postoperative diagnostic procedure in our colposcopy unit, Laser surgery was carried out on patients with VIN in hairiest areas. No patient had any previous radiotherapy. Laser surgery was carried out under colposcopic guidance, The depth of vaporisation was 2 mm, a morphometric study was done on the preoperative histology, Summing up, we can say;hat the colposcopically guided laser surgery was very well tolerated by the patients, It proved efficient as an organ-preserving therapy for VIN II/III an VaIN II/III. 67% of the VIN II/III patients were free from disease for at least one pear after one laser therapy. 25% of the patients had to have two laser therapies to be free from disease for at least one year. 8% of the patients finally had conventional surgery because of VIN recurrence after several laser therapies, There was net development of VIN to invasive cancer in any patient, There were no severe complications. All patients had good cosmetic results. Patients with VIN and CIN seemed to brave significantly higher rates of recurrences after laser therapy, There was a high percentage of patients (42%) with positive HPV 16 (detected by PCR). 42% of the patients had DNA aneuploidies, 56% of the VaIN II/III patients were free from disease for at least one year after one laser therapy. 21% of the patients had to have two laser therapies to be free from disease for at least one year. 21% of the patients finally had conventional surgery because of VaIN recurrence after several laser therapies, There was no development of VaIN to invasive cancer in any patient. There were no severe complications. The majority of recurrences occurred within the first 6 months after therapy. Patients with VaIN III, a long history of VaIN, a positive HPV 16 report, and DNA aneuploidies seemed to have higher rates of recurrences after laser therapy There was a high percentage of patients with positive HPV 16 (50%) and DNA-aneuploidies (42%). 3 Patients with VaIN did not have any GIN, VIN or invasive cancer. This stresses the importance of colposcopy in the gynaecological examination procedure for the prevention of cancer.