The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Neil B. Rosenshein - One of the best experts on this subject based on the ideXlab platform.
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Ultrasonic surgical aspiration for Vaginal Intraepithelial Neoplasia
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2009Co-Authors: Koji Matsuo, Dennis S. Chi, Latashia D. Walker, Neil B. RosensheinAbstract:Abstract Objective To determine the safety and efficacy of ultrasonic surgical aspiration (USA) in the treatment of Vaginal Intraepithelial Neoplasia (VAIN). Methods Using the ICD code for VAIN, all patients who underwent USA were evaluated. Patient demographics, clinicopathologic data, and follow-up outcomes were abstracted from the medical records. Results Ninety-two patients underwent USA for VAIN. No surgical complications or postoperative scarring were recorded, and all patients were followed without further therapy after the procedure. Pathologic evaluation of the degree of VAIN in the aspirate obtained at the time of USA correlated with the preoperative biopsy results in all cases. With a median follow-up period of 4.5 years, the overall recurrence rate was 19.6%. The recurrence rate for high grade VAIN was significantly greater than that for low grade VAIN (32.3% vs 13.1%, P = 0.044). Conclusion Ultrasonic surgical aspiration is a safe and effective surgical option for VAIN, providing a histologic sample with minimal invasiveness.
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Cavitational ultrasonic surgical aspiration for the treatment of Vaginal Intraepithelial Neoplasia.
Gynecologic oncology, 2000Co-Authors: Jubilee B. Robinson, Charlotte C. Sun, Diane Bodurka-bevers, Neil B. RosensheinAbstract:Abstract Objective. The aim of this study is to determine whether cavitational ultrasonic surgical aspiration (CUSA) is effective and safe for treating Vaginal Intraepithelial Neoplasia (VAIN). Methods. We conducted a retrospective chart review of 46 patients who were treated with CUSA for VAIN in a single gynecologic oncology practice between 1981 and 1999. Results. At initial presentation, 39% of treated patients had grade I VAIN, 20% had grade II, and 41% had grade III. The mean duration of follow-up from initial CUSA treatment was 21 months. Twenty-nine patients (63%) were initially treated with CUSA, 7 patients (15%) with laser vaporization, 7 patients (15%) with surveillance by Papanicolaou smear, 1 patient (2%) with partial vaginectomy, 1 patient (2%) with 5-fluorouracil, and 1 patient (2%) with loop excision. Patients initially treated with CUSA had a higher percentage of grade III VAIN at diagnosis (48%) than did patients initially treated with other methods (29%). A significantly greater proportion of patients initially treated with CUSA had no recurrence of VAIN (66%) compared with patients initially treated with other methods (0%) (P Conclusion. These initial data suggest that CUSA is a safe and effective method for treating VAIN and may be an appropriate treatment for many patients.
Yun Hwan Kim - One of the best experts on this subject based on the ideXlab platform.
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Total vaginectomy for refractory Vaginal Intraepithelial Neoplasia III of the Vaginal vault.
Obstetrics & gynecology science, 2016Co-Authors: Ju Hyun Youn, Min Ah Lee, Seoung Cheol Kim, Yun Hwan KimAbstract:Vaginal Intraepithelial Neoplasia III, is a relatively rare disease. Consequently standard treatments for this disease were not established until recently. Although several convenient methods, such as laser ablation, 5-fluorouracil topical injection, and radiation therapy, have been applied for treating these lesions, surgical treatments, including vaginectomy, have not yet been attempted, as they would likely be accompanied by technical difficulties and various complications. Herein, we report a case of refractory Vaginal Intraepithelial Neoplasia III in the Vaginal vault that was successfully treated with a total vaginectomy.
Mitchel S. Hoffman - One of the best experts on this subject based on the ideXlab platform.
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Upper vaginectomy for the treatment of Vaginal Intraepithelial Neoplasia.
American journal of obstetrics and gynecology, 2005Co-Authors: Megan D. Indermaur, Martin A Martino, James V. Fiorica, William S. Roberts, Mitchel S. HoffmanAbstract:Objective The purpose of this study was to evaluate the use of upper vaginectomy for the treatment of Vaginal Intraepithelial Neoplasia (VAIN). Study design We conducted a retrospective review. Between August 1, 1985 and April 30, 2004, 105 patients were identified who had undergone upper vaginectomy for VAIN. Results Thirty-six patients had previously been treated for VAIN. Mean operative time and estimated blood loss were 55 minutes and 113 mL, respectively. Ten percent had intraoperative complications. Twenty-three (22%) patients had negative findings on final pathologic examination, and invasive cancer was found in 13 (12%) patients. Four patients had postoperative complications. Follow-up was available in 52 patients; 46 (88%) remain without recurrence at a mean follow-up of 25 months. Conclusion In our patients, upper vaginectomy was efficacious for the treatment of VAIN. The procedure led to the diagnosis of occult invasive cancer in 12% of these women.
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Laser vaporization of grade 3 Vaginal Intraepithelial Neoplasia
American Journal of Obstetrics and Gynecology, 1991Co-Authors: Mitchel S. Hoffman, James V. Fiorica, William S. Roberts, James P. Lapolla, Denis CavanaghAbstract:Between March 1, 1984, and May 23, 1990, 26 patients underwent laser vaporization for grade 3 Vaginal Intraepithelial Neoplasia. Twenty of these patients had prior hysterectomy, 12 of them because of cervical Neoplasia. Ten patients had undergone prior treatment for Vaginal Intraepithelial Neoplasia. Eleven (42%) developed recurrence of Vaginal Neoplasia with a mean time to recurrence of 22 weeks. Three of the 11 patients had invasive cancer at the time of recurrence. One patient had invasive cancer on biopsy at the time of laser vaporization and subsequently underwent radiation therapy. The remaining 14 patients remain alive with no evidence of recurrent disease at a mean follow-up interval of 117 weeks. In our hands, laser vaporization did not appear to be efficacious treatment for grade 3 Vaginal Intraepithelial Neoplasia, especially when diagnosed in the region of a Vaginal cuff scar.
E Mctigue - One of the best experts on this subject based on the ideXlab platform.
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Vaginal Intraepithelial Neoplasia: risk factors for persistence, recurrence, and invasion and its management.
American journal of obstetrics and gynecology, 1997Co-Authors: F H Sillman, R G Fruchter, Y S Chen, L Camilien, A Sedlis, E MctigueAbstract:Our purpose was to profile patients with Vaginal Intraepithelial Neoplasia, evaluate the response to treatment and define risk factors for persistence and progression. We reviewed records and histopathology slides of 94 patients with Vaginal Intraepithelial Neoplasia diagnosed from 1977 to 1986. For 74 patients with follow-up, we evaluated risk factors by univariate and multivariate analyses. Sixty-four of 94 patients (68%) had prior or concurrent anogenital squamous Neoplasia, including 21 with invasive and 43 with Intraepithelial. Twenty-three had prior radiotherapy, 10 had anogenital neoplastic syndrome, and 11 were immunosuppressed. In 52 of 74 treated patients (70%), Vaginal Intraepithelial Neoplasia went into remission after a single treatment. In 18 patients (70%) Vaginal Intraepithelial Neoplasia went into remission after a single treatment. In 18 patients (24%) recurrent Vaginal Intraepithelial Neoplasia went into remission after chemosurgery, upper vaginectomy, or other treatments; in 4 (5%) it progressed to invasion. Significant multivariate risk factors for persistence or progression were multifocal lesions and anogenital neoplastic syndrome but not Vaginal Intraepithelial Neoplasia grade, associated cervical Neoplasia, or immunosuppression. Although most Vaginal Intraepithelial Neoplasia goes into remission after treatment, 5% of cases may progress from occult foci to invasion in spite of close follow-up.
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Vaginal Intraepithelial Neoplasia: Risk factors for persistence, recurrence, and invasion and its management
American Journal of Obstetrics and Gynecology, 1997Co-Authors: R G Fruchter, Y S Chen, L Camilien, A Sedlis, E MctigueAbstract:Abstract OBJECTIVES: Our purpose was to profile patients with Vaginal Intraepithelial Neoplasia, evaluate the response to treatment, and define risk factors for persistence and progression. STUDY DESIGN: We reviewed records and histopathology slides of 94 patients with Vaginal Intraepithelial Neoplasia diagnosed from 1977 to 1986. For 74 patients with follow-up, we evaluated risk factors by univariate and multivariate analyses. RESULTS: Sixty-four of 94 patients (68%) had prior or concurrent anogenital squamous Neoplasia, including 21 with invasive and 43 with Intraepithelial. Twenty-three had prior radiotherapy, 10 had anogenital neoplastic syndrome, and 11 were immunosuppressed. In 52 of 74 treated patients (70%), Vaginal Intraepithelial Neoplasia went into remission after a single treatment. In 18 patients (24%) recurrent Vaginal Intraepithelial Neoplasia went into remission after chemosurgery, upper vaginectomy, or other treatments; in 4 (5%) it progressed to invasion. Significant multivariate risk factors for persistence or progression were multifocal lesions and anogenital neoplastic syndrome but not Vaginal Intraepithelial Neoplasia grade, associated cervical Neoplasia, or immunosuppression. CONCLUSIONS: Although most Vaginal Intraepithelial Neoplasia goes into remission after treatment, 5% of cases may progress from occult foci to invasion in spite of close follow-up. (Am J. Obstet Gynecol 1997;176:93-9.)
Hidemichi Watari - One of the best experts on this subject based on the ideXlab platform.
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in vivo optical cellular diagnosis for uterine cervical or Vaginal Intraepithelial Neoplasia using flexible gastrointestinal endocytoscopy a prospective pilot study
BMC Cancer, 2020Co-Authors: Shoko Ono, Ayako Nozaki, Kana Matsuda, Emi Takakuwa, Naoya Sakamoto, Hidemichi WatariAbstract:BACKGROUUND For patients with any kind of atypical squamous Intraepithelial lesion of the uterine cervix or vagina, colposcopy and punch biopsy are common procedures for histological determination following cytology. However, colposcopy-guided biopsy does not provide a high level of diagnostic accuracy. The aim of this study was to determine the usefulness of optical biopsy in vivo using endocytoscopy compared with conventional procedures using colposcopy. METHODS Between May 2018 and March 2019, patients who were scheduled for cervical conization or mapping biopsies of the vagina were prospectively enrolled. Endocytoscopy was performed by senior endoscopists prior to scheduled procedures, and endocytoscopic images and biopsy samples were taken from the most prominent site and surrounding area of the cervical or Vaginal lesions. The collection process of images was randomized and anonymous, and three doctors separately evaluated the images according to the ECA classification. ECA 4 and 5 are indicative of endoscopic malignancy. The primary endpoint was diagnostic accuracy (benign or malignant: cervical Intraepithelial Neoplasia (CIN) 3 or Vaginal Intraepithelial Neoplasia (VAIN) 3 or worse) of cell images at the most prominent site in each patient. RESULTS A total of 28 consecutive patients were enrolled. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endocytoscopic images were 95.0% (84.8-98.6%), 87.5% (61.9-96.5%), 95.0% (84.8-98.6%), 87.5% (61.9-96.5%) and 92.9% (78.2-98.0%), respectively. Inter-observer agreement among three reviewers was 0.78 (0.08-9.88, P < 0.01). On the other hand, the accuracy of colposcopy-guided biopsy was 74.1% (64.0-84.0%). CONCLUSIONS Optical cell diagnosis of cervical or Vaginal Intraepithelial Neoplasia using endocytoscopy provides a high level of diagnostic accuracy. TRIAL REGISTRATION The study was registered with the UMIN database (ID: 000031712 ). UMIN000031712 . Registered 16 March 2017.
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In vivo optical cellular diagnosis for uterine cervical or Vaginal Intraepithelial Neoplasia using flexible gastrointestinal endocytoscopy - a prospective pilot study-
2020Co-Authors: Shoko Ono, Ayako Nozaki, Kana Matsuda, Emi Takakuwa, Naoya Sakamoto, Hidemichi WatariAbstract:Abstract BackgrouundFor patients with any kind of atypical squamous Intraepithelial lesion of the uterine cervix or vagina, colposcopy and punch biopsy are common procedures for histological determination following cytology. However, colposcopy-guided biopsy does not provide a high level of diagnostic accuracy. The aim of this study was to determine the usefulness of optical biopsy in vivo using endocytoscopy compared with conventional procedures using colposcopy.MethodsBetween May 2018 and March 2019, patients who were scheduled for cervical conization or mapping biopsies of the vagina were prospectively enrolled. Endocytoscopy was performed by senior endoscopists prior to scheduled procedures, and endocytoscopic images and biopsy samples were taken from the most prominent site and surrounding area of the cervical or Vaginal lesions. The collection process of images was randomized and anonymous, and three doctors separately evaluated the images according to the ECA classification. ECA 4 and 5 are indicative of endoscopic malignancy. The primary endpoint was diagnostic accuracy (benign or malignant: cervical Intraepithelial Neoplasia (CIN) 3 or Vaginal Intraepithelial Neoplasia (VAIN) 3 or worse) of cell images at the most prominent site in each patient.ResultsA total of 28 consecutive patients were enrolled. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of endocytoscopic images were 95.0% (84.8-98.6%), 87.5% (61.9-96.5%), 95.0% (84.8-98.6%), 87.5% (61.9-96.5%) and 92.9% (78.2-98.0%), respectively. Inter-observer agreement among three reviewers was 0.78 (0.08-9.88, P < 0.01). On the other hand, the accuracy of colposcopy-guided biopsy was 74.1% (64.0-84.0%).ConclusionsOptical cell diagnosis of cervical or Vaginal Intraepithelial Neoplasia using endocytoscopy provides a high level of diagnostic accuracy.Trial registrationThe study was registered with the UMIN database (ID: 000031712).UMIN000031712. Registered 16 March 2017, https://rctportal.niph.go.jp/detail/um?trial_id=UMIN000031712
