Top

Published in:

Open Access 01-04-2022 | CO2 Laser | Original Article

CO2 laser colposcopic guided surgery for the see and treat management of VHSIL: a preliminary experience

Authors: C. Bianchi, N. Auzzi, I. Turrini, A. De Magnis, M. G. Fallani, M. Fambrini, A. Pieralli

Published in: Lasers in Medical Science | Issue 3/2022

Abstract

The purpose of this study is to evaluate the efficiency of CO2 laser colposcopic guided surgery performed in an outpatient see and treat setting in the management of VHSIL. Women with a suspected diagnosis of VHSIL and no vulvoscopic suspicion of vSCC were enrolled. An electronic register of CO2 laser treatment was created where description of performing parameters (excision or ablation) was specified and personal history was recorded. Statistical analysis was performed by Fisher’s exact test. Relative risks (RR) of risk factor were calculated and expressed in odds. From September 2014 to September 2018, we enrolled a total of 63 patients who underwent CO2 laser procedure and had a minimum follow-up time of 2 years at Careggi University Hospital in Florence. Forty-eight (76.2%) patients underwent laser excision and 15 (23.8%) patients underwent ablative treatment without histological results. Undertreatment was performed in 3 cases (6.3%) with definitive histology of vSCC. Therapeutical appropriateness of CO2 laser excision was reached in 85.4% of the cases (41/48). No volunteer loss to follow-up was registered; thus, fidelity to treatment was assess at 100%. Recurrence rate within 2 years attested in 8/60 followed patients (13.3%). No personal factor was found to influence the VHSIL course. CO2 laser excision may represent an excellent therapeutic option to VHSIL because it provides adequate oncological purpose with good cosmetic and functional results and high patients’ loyalty to treatment. An expert team could allow to undergo patients with VHSIL suspicion to unique diagnostic and therapeutic procedure with significant benefits.

Hoang LN, Park KJ, Soslow RA, Murali R (2016) Squamous precursor lesions of the vulva: current classification and diagnostic challenges. Pathology 48(4):291–302. https://doi.org/10.1016/j.pathol.2016.02.015CrossRefPubMed

Østergård S, Vorbeck CS, Meinert M (2018) Vulvar intraepithelial neoplasia. Ugeskr Laeger 180(20): 2–5. V12170931PubMed

Rasmussen CL, Thomsen LT, Aalborg GL, Kjaer SK (2020) Incidence of vulvar high-grade precancerous lesions and cancer in Denmark before and after introduction of HPV vaccination. Gynecol Oncol 157(3):664–670. https://doi.org/10.1016/j.ygyno.2020.03.030CrossRefPubMed

St Laurent J, Luckett R, Feldman S (2018) HPV vaccination and the effects on rates of HPV-related cancers. Curr Probl Cancer 42(5):493–506. https://doi.org/10.1016/j.currproblcancer.2018.06.004CrossRefPubMed

Singh N, Gilks CB (2020) Vulval squamous cell carcinoma and its precursors. Histopathology 76(1):128–138. https://doi.org/10.1111/his.13989CrossRefPubMed

(2016) Committee Opinion No.675: Management of vulvar intraepithelial neoplasia. American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice; American Society for Colposcopy and Cervical Pathology (ASCCP). Obstet Gynecol 128(4):178–182. https://doi.org/10.1097/AOG.0000000000001713

Zhao S, Liu D, Shi W, Kang Y, Li Q, Liu Q, Chen M, Li F, Su J, Zhang Y, Wu L (2020) Efficacy of a new therapeutic option for vulvar intraepithelial neoplasia: superficial shaving combined with photodynamic therapy. Lasers Surg Med 52(6):488–495. https://doi.org/10.1002/lsm.23185CrossRefPubMed

Stern PL, Van der Burg SH, Hampson IN, Broker TR, Fiander A, Lacey CJ, Kitchener HC, Einstein MH (2012) Therapy of human papillomavirus-related disease. Vaccine 30(Suppl 5(05)):71–82. https://doi.org/10.1016/j.vaccine.2012.05.091CrossRef

Tristram A, Hurt CN, Madden T, Powell N, Man S, Hibbitts S, Dutton P, Jones S, Nordin AJ, Naik R, Fiander A, Griffiths G (2014) Activity, safety, and feasibility of cidofovir and imiquimod for treatment of vulval intraepithelial neoplasia (RT³VIN): a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 15(12):1361–1368. https://doi.org/10.1016/S1470-2045(14)70456-5CrossRefPubMed

10.

Iavazzo C, Pitsouni E, Athanasiou S, Falagas ME (2008) Imiquimod for treatment of vulvar and vaginal intraepithelial neoplasia. Int J Gynaecol Obstet 101(1):3–10. https://doi.org/10.1016/j.ijgo.2007.10.023CrossRefPubMed

11.

Tosti G, Iacobone AD, Preti EP, Vaccari S, Barisani A, Pennacchioli E, Cantisani C (2018) The role of photodynamic therapy in the treatment of vulvar intraepithelial neoplasia. Biomedicines 6(1):13. https://doi.org/10.3390/biomedicines6010013CrossRefPubMedCentral

12.

Satmary W, Holschneider CH, Brunette LL, Natarajan S (2018) Vulvar intraepithelial neoplasia: risk factors for recurrence. Gynecol Oncol 148(1):126–131. https://doi.org/10.1016/j.ygyno.2017.10.029CrossRefPubMed

13.

Sideri M, Spinaci L, Spolti N, Schettino F (1999) Evaluation of CO(2) laser excision or vaporization for the treatment of vulvar intraepithelial neoplasia. Gynecol Oncol 75(2):277–281. https://doi.org/10.1006/gyno.1999.5584CrossRefPubMed

14.

Penna C, Fallani MG, Fambrini M, Zipoli E, Marchionni M (2002) CO2 laser surgery for vulvar intraepithelial neoplasia. Excisional, destructive and combined techniques. J Reprod Med 47(11):913–918PubMed

15.

Hoffman MS, Pinelli DM, Finan M, Roberts WS, Fiorica JV, Cavanagh D (1992) Laser vaporization for vulvar intraepithelial neoplasia III. J Reprod Med 37(2):135–137PubMed

16.

Küppers V, Stiller M, Somville T, Bender HG (1997) Risk factors for recurrent VIN. Role of multifocality and grade of disease. J Reprod Med 42(3):140–144PubMed

17.

Fallani MG, Fambrini M, Lozza V, Bianchi C, Pieralli A (2012) CO2 laser total superficial vulvectomy: an outpatient treatment for wide multifocal vulvar intraepithelial neoplasia grade 3. J Minim Invasive Gynecol 19(6):758–761. https://doi.org/10.1016/j.jmig.2012.08.005CrossRef

18.

Van Esch EMG, Dam MCI, Osse MEM, Putter H, Trimbos BJBMZ, Fleuren G, Van der Burg SH, Van Poelgeest MIE (2013) Clinical characteristics associated with development of recurrence and progression in usual-type vulvar intraepithelial neoplasia. Int J Gynecol Cancer 23(8):1476–1483. https://doi.org/10.1097/IGC.0b013e3182a57fd6CrossRefPubMed

19.

Preti M, Scurry J, Marchitelli CE, Micheletti L (2014) Vulvar intraepithelial neoplasia. Best Pract Res Clin Obstet Gynaecol 28(7):1051–1062. https://doi.org/10.1016/j.bpobgyn.2014.07.010CrossRefPubMed

20.

Nugent KE, Brooks RA, Barr CD, Case AS, Mutch DG, Massad LS (2011) Clinical and pathologic features of vulvar intraepithelial neoplasia in premenopausal and postmenopausal women. J Low Genit Tract Dis 15(1):15–9. https://doi.org/10.1097/LGT.0b013e3181ee2598CrossRefPubMed

21.

Green N, Adedipe T, Dmytryshyn J, Preti M, Amanda A (2020) Management of Vulvar Cancer precursors: a survey of the International Society for the Study of Vulvovaginal Disease. J Low Genit Tract Dis 24(4):387–391. https://doi.org/10.1097/LGT.0000000000000559CrossRefPubMed

Title: CO2 laser colposcopic guided surgery for the see and treat management of VHSIL: a preliminary experience
Authors: C. Bianchi
N. Auzzi
I. Turrini
A. De Magnis
M. G. Fallani
M. Fambrini
A. Pieralli
Publication date: 01-04-2022
Publisher: Springer London
Keywords: CO2 Laser
Laser
Published in: Lasers in Medical Science / Issue 3/2022
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI: https://doi.org/10.1007/s10103-021-03413-y

At a glance: The STEP trials

Springer Medicine

CO2 laser colposcopic guided surgery for the see and treat management of VHSIL: a preliminary experience

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2022

Effect of curcumin-encapsulated Pluronic® F-127 over duo-species biofilm of Streptococcus mutans and Candida albicans

LED photobiomodulation therapy combined with biomaterial as a scaffold promotes better bone quality in the dental alveolus in an experimental extraction model

Monte Carlo simulations of photodynamic therapy in human blood model

Effects of photobiomodulation on glucose homeostasis and morphometric parameters in pancreatic islets of diabetic mice

Histology changes of in vivo human skin after treatment with fractional 1064 nm Nd:YAG picosecond laser in different energy settings

Selective laser trabeculoplasty lowered the untreated fellow eye long-term intraocular pressure: a 3-year observational study