ORIGINAL RESEARCH ARTICLE:VULVA AND VAGINAOPENThe European Society of Gynaecological Oncology (ESGO),the International Society for the Study of Vulvovaginal Disease(ISSVD),the European College for the Study of Vulval Disease(ECSVD),and the European Federation for Colposcopy (EFC)Consensus Statement on the Management of VaginalIntraepithelial NeoplasiaVesna Kesic,MD.Xavier Carcopino,MD.Mario Preti,MD,3 Pedro Vieira-Baptista,MD,45Federica Bevilacqua,MD,3 Jacob Bornstein,MD,Cyrus Chargari,MD,?Maggie Cruickshank,MD,sEmre Erzeneoglu,MD,Niccolo Gallio,MD,3 Murat Gultekin,MD,1 Debra Heller,MD,Elmar Joura,MD,2Maria Kyrgiou,MD,314 Tatjana Madic,MD,5 Frangois Planchamp,MD.Sigrid Regauer;MD,Olaf Reich.MD.Bilal Esat Temiz,MD Linn Woelber:MD..20Jana Zodzika,MD,2!and Colleen Stockdale,MD22tensive and persistent disease.Carbon dioxide(CO2)laser may be usedAbstract:The European Society of Gynaecological Oncology (ESGO),as both an ablation method and an excisional one.Reported cure rates afterthe Intemational Society for the Study of Vulvovaginal Disease (ISSVD).laserexcision and laserablation are similar.Topical agents are useful for per-the European College for the Study of Vulval Disease (ECSVD),and thesistent,multifocal lesions or for patients who cannot undergo surgical treat-European Federation for Colposcopy (EFC)developed consensus state-ment.Imiquimod was associated with the lowest recurrence rate,highest hu-ments on pre-invasive vulvar lesions in order to improve the quality of carefor patients with vaginal intracpithelial neoplasia(ValN).The managementman papillomavirus(HPV)clearance,and can be considered the best topicalof VaIN varies according to the grade of the lesion:ValN 1 (low grade vag-approch.Trichloroacetic acid and 5-fluorouracil are historical options andshould be discouraged.For ValN after hysterectomy for cervical intraepitheinal squamous intraepithelial lesions (SIL))can be subjected to follow-up,lial neoplasia (CIN)3,laser vaporization and topical agents are not the bestwhile ValN 2-3(high-grade vaginal SIL)should be treated.Treatmentoptions,since they cannot reach epithelium buried in the vaginal scar.Inneeds individualization according to the patient's characteristics,diseasethese cases surgical options are preferable.Brachytherapy has a high overallextension and previous therapeutic procedures.Surgical excision is thesuccess rate but due to late side effects should be reserved for poor surgicalmainstay of treatment and should be performed if invasion cannot becandidates,having multifocal disease,and with failed prior treatments.ValNexcluded.Total vaginectomy is used only in highly selected cases ofex-tends to recur and ensuring patient adherence to close follow-up visits is ofMedical Faculty,University of Belgrade,Clinic of Obstctrics and Gynecology,The present document was developed by ESGO,ISSVD,ECSVD and EFC andUniversity Clinical Center of Serbia,Belgrade,Serbia:Department of Obstet-is published in the International fournal of Gw
