title: A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia.
abstract: OBJECTIVE
  The purpose of this study was to review a large cohort of patients with vaginal intraepithelial neoplasia (VAIN) and to analyze the epidemiology and outcomes with various treatment modalities.
  
  
  METHODS
  A retrospective chart review was performed that encompassed patients who were treated for VAIN at a single center from 1990-2007. Demographics, disease characteristics, referring cytology, and histologic information were recorded. Primary outcome was recurrence or progression to carcinoma. Statistical analyses were performed with statistical software.
  
  
  RESULTS
  One hundred sixty-three women were included in the study: median age, 50 years (range, 21-84 years); white, 87%; current or previous smokers, 35%. At the time of diagnosis, 23% of the women had VAIN1; 37% of the women had VAIN2, and 35% of the women had VAIN3. Referral Papanicolaou smear results of high-grade squamous intraepithelial lesion or atypical glandular cells revealed VAIN2 or VAIN3 in 89% of cases (P = .0019) vs 53% of cases with low-grade squamous intraepithelial lesion. The median follow-up period was 18 months (range, 1-194 months). VAIN1 was observed in 70% of cases; 71% of patients who were treated for VAIN1 had recurrence or progression. VAIN2 was treated in 77% of patients; 53% of those who were treated had recurrence or progression. VAIN3 was treated in 94% of cases; 31% of them had recurrence or progression. Risk of recurrence was not correlated to VAIN type (P = .3). Six carcinomas were discovered in patients with VAIN2 and VAIN3. Median time to progression was 17 months for VAIN1, 11 months for VAIN2, and 11 months for VAIN3 (P = .036).
  
  
  CONCLUSIONS
  Despite the subtype, VAIN often recurs but does so more quickly with higher grade dysplasia.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. camille-gunderson@ouhsc.edu
authors: Camille C
authors: CC
authors: Gunderson
authors: Elizabeth K
authors: EK
authors: Nugent
authors: Stacie H
authors: SH
authors: Elfrink
authors: Michael A
authors: MA
authors: Gold
authors: Kathleen N
authors: KN
authors: Moore
mesh_terms: D055011:Ablation Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009825:Oklahoma / Q000453:epidemiology; D065006:Papanicolaou Test; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy; D014626:Vaginal Smears
chemical_list: D000970:Antineoplastic Agents