title: Management of multicentric lesions of the lower genital tract.
abstract: OBJECTIVE
  To report management and outcome of multicentric lesions of the lower genital tract. To define risk factors of recurrence.
  
  
  METHODS
  Retrospective review of multicentric dysplasias treated in our colposcopic clinic between 1996 and 2003. Multicentric dysplasias included CIN with VAIN and/or VIN. After primary treatment, follow-up was colposcopic, cytologic and virologic.
  
  
  RESULTS
  Forty-four patients presented multicentric lesions out of 998 patients referred for CIN (4.4%). The average age was 36.8 years. Immunologic disorders were present in 20.4%. Ninety-one percent had cervicovaginal or cervicovulvar lesions, only 9% had three sites of genital dysplasia. 53.3% of lesions were concomitant. 79.5% of CIN were high grade, 62.5% of VAIN low grade and 62.5% of VIN high grade. Therapeutic modalities were as follows: conization for CIN (70.4%), CO2 laser for VAIN (33.3%) and surgery for VIN (41.7%). Forty patients were followed and had at least one post-treatment cytologic control; 55% of them had residual disease. Out of the 23 patients with at least two negative controls after treatment, 43.5% presented recurrence. Risk of recurrence was not statistically bound to such parameters as tabagism, immunologic disorder, high grade lesions, non-surgical treatment, and persistence of HPV infection after treatment.
  
  
  CONCLUSIONS
  Multicentric dysplasias are associated with high rate of residual lesion and recurrence. Management of these lesions require long term follow-up.
authors.affiliation: Hôpital Jeanne de Flandre, Clinique de Gynécologie, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59 037 Lille Cedex, France.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ait Menguellet
authors.forename: Pierre
authors.initials: P
authors.lastname: Collinet
authors.forename: Véronique
authors.initials: V
authors.lastname: Houfflin Debarge
authors.forename: Madi
authors.initials: M
authors.lastname: Nayama
authors.forename: Denis
authors.initials: D
authors.lastname: Vinatier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Leroy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D003452:Cryosurgery; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*; D014625:Vaginal Neoplasms / Q000628:therapy*; D014846:Vulvar Neoplasms / Q000628:therapy*; D002578:Uterine Cervical Dysplasia / Q000628:therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil