Management of multicentric lesions of the lower genital tract.
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.
Ait Menguellet
Sonia
S
Hôpital Jeanne de Flandre, Clinique de Gynécologie, Centre Hospitalier Régional Universitaire de Lille, 2 Avenue Oscar Lambret, 59 037 Lille Cedex, France.
Collinet
Pierre
P
Houfflin Debarge
Véronique
V
Nayama
Madi
M
Vinatier
Denis
D
Leroy
Jean-Louis
JL
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*
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil