Lazer vaporization of vaginal intraepithelial neoplasia: A word of caution

摘要

To the Editor: Perrotta et al. [1] report that 9 (43%) of 21 of their patients treated with laser vaporization of high-grade vaginal intraepithelial neoplasia (VAIN) had a history of high-grade cervical intraepithelian neoplasia (CIN) "of whom 8 had undergone hysterectomy on this account." One woman presented with invasive cancer 30 months after 2 laser treatments. A word of caution. Over the years, I have encountered a number of women with vaginal vault cancer, who have previously had a hysterectomy (usually abdominal) for high-grade CIN and who have subsequently undergone ablative treatments of vault VAIN. The cancers have sometimes appeared only after lengthy periods of normal vaginal cytology follow-up. In some cases, it was possible to confirm retrospectively incomplete excision of CIN at the hysterectomy vaginal margin. In these cases, it is likely that the cancer evolved from incompletely excised CIN 3/VAIN 3 buried in the vault at the time of hysterectomy.