title: High-grade vaginal intraepithelial neoplasia: can we be selective about who we treat?
abstract: OBJECTIVE
  To determine the role of conservative management in high-grade vaginal intraepithelial neoplasia (HG VaIN).
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Northern Gynaecological Oncology Centre, Gateshead, UK.
  
  
  METHODS
  A total of 100 women with histologically-proven HG VaIN.
  
  
  METHODS
  Review of patient records from 1995 to 2011.
  
  
  METHODS
  Rates of progression to cancer, treatment remission, and disease recurrence, particularly post-treatment when vaginoscopy is normal but cytology is abnormal.
  
  
  RESULTS
  Of 100 women referred, 69 underwent initial treatment of whom 47 (68%) went into remission: of these, seven developed a recurrence after a median follow-up of 29 months (range 15-214 months). Of the 31 women managed conservatively with cytological and vaginoscopic surveillance, no cancers developed after a median follow-up of 35 months (range 2-230 months). Rate of overall progression to cancer was 3% and all were detected among the initial treatment group after a median of 59 months (range 8-249 months). Post-treatment, when normal vaginoscopy was accompanied by abnormal cytology, two categories existed. Of 24 cases with low-grade cytological abnormality, recurrence of HG VaIN occurred in seven (29%) after a median follow-up of 12 months (range 2-110 months). Of 19 cases with HG cytological abnormality, 15 (79%) developed recurrence at a median follow-up of 7 months (range 2-21 months), giving a hazard ratio 5.6 (95% confidence interval 2.0-15.5, P = 0.001).
  
  
  CONCLUSIONS
  It is possible to select women with HG VaIN for conservative surveillance with excellent results. The majority of women undergoing initial treatment will enter remission. Post-treatment, if cytological abnormality develops in the presence of normal vaginoscopy, the majority of women will develop histological HG VaIN recurrence.
authors.affiliation: Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK. nithya.ratnavelu@ghnt.nhs.uk
authors.forename: N
authors.initials: N
authors.lastname: Ratnavelu
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: A D
authors.initials: AD
authors.lastname: Fisher
authors.forename: K
authors.initials: K
authors.lastname: Galaal
authors.forename: P
authors.initials: P
authors.lastname: Cross
authors.forename: R
authors.initials: R
authors.lastname: Naik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000628:therapy*; D003127:Colposcopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D014625:Vaginal Neoplasms / Q000473:pathology / Q000628:therapy*; D014626:Vaginal Smears; D057832:Watchful Waiting