Vaginal Intraepithelial Neoplasia (VaIN): Diagnosis and Management

  • Xingnan Zhou
  • Tien Anh Nguyen Tran
  • Robert W. Holloway


Vaginal intraepithelial neoplasia (VaIN) is a relatively uncommon and asymptomatic preneoplastic lesion associated with human papillomavirus (HPV) of the lower genital tract. The diagnosis is usually suspected with abnormal cervical-vaginal cytology and confirmed by punch biopsy. The treatment of VaIN varies depending on several factors including grade of the dysplasia, location, and extent of lesions, patients’ characteristics including age and onset of HPV infection, and previous therapeutic procedures. The four main treatment methods include surgery, ablation, topical therapies, and radiation (brachytherapy). All treatments have reasonably good success but are limited by their unique side effects, and all are associated with some risk for recurrence. Patients require long-term monitoring to survey for recurrence or progression to vaginal cancer. HPV vaccination is a promising strategy to reduce the incidence of VaIN and vaginal cancer.


Vaginal intraepithelial neoplasia (VaIN) Cytology Biopsy Vaginectomy CO2 laser Loop electrosurgical excision procedure (LEEP) Cavitational ultrasonic surgical aspiration (CUSA) Photodynamic therapy (PDT) Imiquimod 5-Fluorouracil (5-FU) Trichloroacetic acid (TCA) Estrogen Brachytherapy HPV vaccine 


  1. 1.
    Henson D, Tarone R. An epidemiologic study of cancer of the cervix, vagina, and vulva based on the Third National Cancer Survey in the United States. Am J Obstet Gynecol. 1977;129(5):525–32.CrossRefGoogle Scholar
  2. 2.
    Watson M, Saraiya M, Wu X. Update of HPV-associated female genital cancers in the United States, 1999-2004. J Women Health (Larchmt). 2009;18(11):1731–8. Scholar
  3. 3.
    Cong Q, Wang Q, Gao SJ, Zhang HW, Du M, Xie F, et al. Detection trend of vaginal intraepithelial neoplasia diagnosed by colposcopy guided biopsy from 2013 to 2015. Zhonghua Fu Chan Ke Za Zhi. 2017;52(4):239–43. Scholar
  4. 4.
    Gunderson CC, Nugent EK, Elfrink SH, Gold MA, Moore KN. A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia. Am J Obstet Gynecol. 2013;208(5):410.e1–6. Scholar
  5. 5.
    Kim MK, Lee IH, Lee KH. Clinical outcomes and risk of recurrence among patients with vaginal intraepithelial neoplasia: a comprehensive analysis of 576 cases. J Gynecol Oncol. 2018;29(1):e6. Scholar
  6. 6.
    Diakomanolis E, Stefanidis K, Rodolakis A, Haidopoulos D, Sindos M, Chatzipappas I, et al. Vaginal intraepithelial neoplasia: report of 102 cases. Eur J Gynaecol Oncol. 2002;23(5):457–9.PubMedGoogle Scholar
  7. 7.
    Dunne EF, Markowitz LE, Saraiya M, Stokley S, Middleman A, Unger ER, et al. CDC grand rounds: reducing the burden of HPV-associated cancer and disease. MMWR Morb Mortal Wkly Rep. 2014;63(4):69–72.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Dodge JA, Eltabbakh GH, Mount SL, Walker RP, Morgan A. Clinical features and risk of recurrence among patients with vaginal intraepithelial neoplasia. Gynecol Oncol. 2001;83(2):363–9. Scholar
  9. 9.
    Kalogirou D, Antoniou G, Karakitsos P, Botsis D, Papadimitriou A, Giannikos L. Vaginal intraepithelial neoplasia (VAIN) following hysterectomy in patients treated for carcinoma in situ of the cervix. Eur J Gynaecol Oncol. 1997;18(3):188–91.PubMedGoogle Scholar
  10. 10.
    Coronel-Brizio P, Olivares Nowak J, Palafox SF. Recurrence of high-grade squamous intraepithelial lesions following hysterectomy. Ginecol Obstet Mex. 1999;67:415–8.PubMedGoogle Scholar
  11. 11.
    Schockaert S, Poppe W, Arbyn M, Verguts T, Verguts J. Incidence of vaginal intraepithelial neoplasia after hysterectomy for cervical intraepithelial neoplasia: a retrospective study. Am J Obstet Gynecol. 2008;199(2):113.e1–5. Scholar
  12. 12.
    Li Z, Barron S, Hong W, Karunamurthy A, Zhao C. Surveillance for recurrent cancers and vaginal epithelial lesions in patients with invasive cervical cancer after hysterectomy: are vaginal cytology and high-risk human papillomavirus testing useful? Am J Clin Pathol. 2013;140(5):708–14. Scholar
  13. 13.
    Piscitelli JT, Bastian LA, Wilkes A, Simel DL. Cytologic screening after hysterectomy for benign disease. Am J Obstet Gynecol. 1995;173(2):424–30. Discussion 30–2CrossRefGoogle Scholar
  14. 14.
    Insinga RP, Liaw KL, Johnson LG, Madeleine MM. A systematic review of the prevalence and attribution of human papillomavirus types among cervical, vaginal, and vulvar precancers and cancers in the United States. Cancer Epidemiol Biomarkers Prev. 2008;17(7):1611–22. Scholar
  15. 15.
    Smith JS, Backes DM, Hoots BE, Kurman RJ, Pimenta JM. Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors. Obstet Gynecol. 2009;113(4):917–24. Scholar
  16. 16.
    Castle PE, Rodriguez AC, Porras C, Herrero R, Schiffman M, Gonzalez P, et al. A comparison of cervical and vaginal human papillomavirus. Sex Transm Dis. 2007;34(11):849–55. Scholar
  17. 17.
    Zaino RJ, Nucci M, Kurman RJ. Diseases of the vagina. In: Kurman RJ, Ellenson LH, Ronnett BM, editors. Blaustein’s pathology of the female genital tract. 6th ed. New York: Springer; 2011. p. 105–54.CrossRefGoogle Scholar
  18. 18.
    Bowen-Simpkins P, Hull MG. Intraepithelial vaginal neoplasia following immunosuppressive therapy treated with topical 5-Fu. Obstet Gynecol. 1975;46(3):360–2.PubMedGoogle Scholar
  19. 19.
    Jamieson DJ, Paramsothy P, Cu-Uvin S, Duerr A. Vulvar, vaginal, and perianal intraepithelial neoplasia in women with or at risk for human immunodeficiency virus. Obstet Gynecol. 2006;107(5):1023–8. Scholar
  20. 20.
    Robboy SJ, Noller KL, O’Brien P, Kaufman RH, Townsend D, Barnes AB, et al. Increased incidence of cervical and vaginal dysplasia in 3,980 diethylstilbestrol-exposed young women. Experience of the National Collaborative Diethylstilbestrol Adenosis Project. JAMA. 1984;252(21):2979–83.CrossRefGoogle Scholar
  21. 21.
    Hatch EE, Herbst AL, Hoover RN, Noller KL, Adam E, Kaufman RH, et al. Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States). Cancer Causes Control. 2001;12(9):837–45.CrossRefGoogle Scholar
  22. 22.
    Sherman JF, Mount SL, Evans MF, Skelly J, Simmons-Arnold L, Eltabbakh GH. Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus. Gynecol Oncol. 2008;110(3):396–401. Scholar
  23. 23.
    Rome RM, England PG. Management of vaginal intraepithelial neoplasia: a series of 132 cases with long-term follow-up. Int J Gynecol Cancer. 2000;10(5):382–90.CrossRefGoogle Scholar
  24. 24.
    Massad LS. Outcomes after diagnosis of vaginal intraepithelial neoplasia. J Low Genit Tract Dis. 2008;12(1):16–9. Scholar
  25. 25.
    Jentschke M, Hoffmeister V, Soergel P, Hillemanns P. Clinical presentation, treatment and outcome of vaginal intraepithelial neoplasia. Arch Gynecol Obstet. 2016;293(2):415–9. Scholar
  26. 26.
    Fehr MK, Baumann M, Mueller M, Fink D, Heinzl S, Imesch P, et al. Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia. J Gynecol Oncol. 2013;24(3):236–41. Scholar
  27. 27.
    Audet-Lapointe P, Body G, Vauclair R, Drouin P, Ayoub J. Vaginal intraepithelial neoplasia. Gynecol Oncol. 1990;36(2):232–9.CrossRefGoogle Scholar
  28. 28.
    Indermaur MD, Martino MA, Fiorica JV, Roberts WS, Hoffman MS. Upper vaginectomy for the treatment of vaginal intraepithelial neoplasia. Am J Obstet Gynecol. 2005;193(2):577–80. Discussion 80–1CrossRefPubMedGoogle Scholar
  29. 29.
    Hoffman MS, DeCesare SL, Roberts WS, Fiorica JV, Finan MA, Cavanagh D. Upper vaginectomy for in situ and occult, superficially invasive carcinoma of the vagina. Am J Obstet Gynecol. 1992;166(1 Pt 1):30–3.CrossRefGoogle Scholar
  30. 30.
    Sopracordevole F, De Piero G, Clemente N, Buttignol M, Mancioli F, Di Giuseppe J, et al. Vaginal intraepithelial neoplasia: histopathological upgrading of lesions and evidence of occult vaginal cancer. J Low Genit Tract Dis. 2016;20(1):70–4. Scholar
  31. 31.
    Sillman FH, Fruchter RG, Chen YS, Camilien L, Sedlis A, McTigue E. Vaginal intraepithelial neoplasia: risk factors for persistence, recurrence, and invasion and its management. Am J Obstet Gynecol. 1997;176(1 Pt 1):93–9.CrossRefGoogle Scholar
  32. 32.
    Gonzalez Sanchez JL, Flores Murrieta G, Chavez Brambila J, Deolarte Manzano JM, Andrade Manzano AF. Topical 5-fluorouracil for treatment of vaginal intraepithelial neoplasms. Ginecol Obstet Mex. 2002;70:244–7.PubMedGoogle Scholar
  33. 33.
    Yalcin OT, Rutherford TJ, Chambers SK, Chambers JT, Schwartz PE. Vaginal intraepithelial neoplasia: treatment by carbon dioxide laser and risk factors for failure. Eur J Obstet Gynecol Reprod Biol. 2003;106(1):64–8.CrossRefGoogle Scholar
  34. 34.
    Hoffman MS, Roberts WS, LaPolla JP, Sterghos S Jr, Cavanagh D. Neoplasia in vaginal cuff epithelial inclusion cysts after hysterectomy. J Reprod Med. 1989;34(6):412–4.PubMedGoogle Scholar
  35. 35.
    Sopracordevole F, Mancioli F, Clemente N, De Piero G, Buttignol M, Giorda G, et al. Abnormal Pap smear and diagnosis of high-grade vaginal intraepithelial neoplasia: a retrospective cohort study. Medicine. 2015;94(42):e1827. Scholar
  36. 36.
    Mouithys P, Papadopoulos C, Allier G, Lanta S, Delpierre C, Najas S, et al. Is it necessary to make screening Pap smears after hysterectomy? Gynecol Obstet Fertil. 2003;31(7–8):620–3.CrossRefGoogle Scholar
  37. 37.
    Frega A, Sopracordevole F, Assorgi C, Lombardi D, DES V, Catalano A, et al. Vaginal intraepithelial neoplasia: a therapeutical dilemma. Anticancer Res. 2013;33(1):29–38.PubMedGoogle Scholar
  38. 38.
    Davila RM, Miranda MC. Vaginal intraepithelial neoplasia and the Pap smear. Acta Cytol. 2000;44(2):137–40.CrossRefGoogle Scholar
  39. 39.
    Bornstein J, Bentley J, Bosze P, Girardi F, Haefner H, Menton M, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120(1):166–72. Scholar
  40. 40.
    Sopracordevole F, Clemente N, Barbero M, Agarossi A, Cattani P, Garutti P, et al. Colposcopic patterns of vaginal intraepithelial neoplasia: a focus on low-grade lesions. Eur Rev Med Pharmacol Sci. 2017;21(12):2823–8.PubMedGoogle Scholar
  41. 41.
    Ireland D, Monaghan JM. The management of the patient with abnormal vaginal cytology following hysterectomy. Br J Obstet Gynaecol. 1988;95(10):973–5.CrossRefGoogle Scholar
  42. 42.
    Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Derdelis G, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia. Eur J Gynaecol Oncol. 2010;31(4):392–4.PubMedGoogle Scholar
  43. 43.
    Patsner B. Treatment of vaginal dysplasia with loop excision: report of five cases. Am J Obstet Gynecol. 1993;169(1):179–80.CrossRefGoogle Scholar
  44. 44.
    Terzakis E, Androutsopoulos G, Zygouris D, Grigoriadis C, Arnogiannaki N. Loop electrosurgical excision procedure in Greek patients with vaginal intraepithelial neoplasia and history of cervical cancer. Eur J Gynaecol Oncol. 2011;32(5):530–3.PubMedGoogle Scholar
  45. 45.
    Powell JL, Asbery DS. Treatment of vaginal dysplasia: just a simple loop electrosurgical excision procedure? Am J Obstet Gynecol. 2000;182(3):731–2.CrossRefGoogle Scholar
  46. 46.
    Harroch J, Siegler E, Bornstein J. Vesicovaginal fistula resulting from loop electrosurgical excision in a woman with intraepithelial neoplasia of the cervix and vagina: a case report. J Low Genit Tract Dis. 2004;8(3):205–6.CrossRefGoogle Scholar
  47. 47.
    Robinson JB, Sun CC, Bodurka-Bevers D, Im DD, Rosenshein NB. Cavitational ultrasonic surgical aspiration for the treatment of vaginal intraepithelial neoplasia. Gynecol Oncol. 2000;78(2):235–41. Scholar
  48. 48.
    Matsuo K, Chi DS, Walker LD, Rosenshein NB, Im DD. Ultrasonic surgical aspiration for vaginal intraepithelial neoplasia. Int J Gynaecol Obstet. 2009;105(1):71–3. Scholar
  49. 49.
    von Gruenigen VE, Gibbons HE, Gibbins K, Jenison EL, Hopkins MP. Surgical treatments for vulvar and vaginal dysplasia: a randomized controlled trial. Obstet Gynecol. 2007;109(4):942–7. Scholar
  50. 50.
    Sopracordevole F, Parin A, Scarabelli C, Guaschino S. Laser surgery in the conservative management of vaginal intraepithelial neoplasms. Minerva Ginecologica. 1998;50(12):507–12.PubMedGoogle Scholar
  51. 51.
    Benedet JL, Wilson PS, Matisic JP. Epidermal thickness measurements in vaginal intraepithelial neoplasia. A basis for optimal CO2 laser vaporization. J Reprod Med. 1992;37(9):809–12.PubMedGoogle Scholar
  52. 52.
    Kim HS, Park NH, Park IA, Park JH, Chung HH, Kim JW, et al. Risk factors for recurrence of vaginal intraepithelial neoplasia in the vaginal vault after laser vaporization. Lasers Surg Med. 2009;41(3):196–202. Scholar
  53. 53.
    Sherman AI. Laser therapy for vaginal intraepithelial neoplasia after hysterectomy. J Reprod Med. 1990;35(10):941–4.PubMedGoogle Scholar
  54. 54.
    Allison RR, Mota HC, Sibata CH. Clinical PD/PDT in North America: an historical review. Photodiagnosis Photodyn Ther. 2004;1(4):263–77. Scholar
  55. 55.
    Allison RR, Cuenca R, Downie GH, Randall ME, Bagnato VS, Sibata CH. PD/PDT for gynecological disease: a clinical review. Photodiagnosis Photodyn Ther. 2005;2(1):51–63. Scholar
  56. 56.
    Fehr MK, Hornung R, Degen A, Schwarz VA, Fink D, Haller U, et al. Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid. Lasers Surg Med. 2002;30(4):273–9.CrossRefGoogle Scholar
  57. 57.
    Choi MC, Kim MS, Lee GH, Jung SG, Park H, Joo WD, et al. Photodynamic therapy for premalignant lesions of the vulva and vagina: a long-term follow-up study. Lasers Surg Med. 2015; Scholar
  58. 58.
    Miller RL, Gerster JF, Owens ML, Slade HB, Tomai MA. Imiquimod applied topically: a novel immune response modifier and new class of drug. Int J Immunopharmacol. 1999;21(1):1–14.CrossRefGoogle Scholar
  59. 59.
    Diakomanolis E, Haidopoulos D, Stefanidis K. Treatment of high-grade vaginal intraepithelial neoplasia with imiquimod cream. N Engl J Med. 2002;347(5):374. Scholar
  60. 60.
    Buck HW, Guth KJ. Treatment of vaginal intraepithelial neoplasia (primarily low grade) with imiquimod 5% cream. J Low Genit Tract Dis. 2003;7(4):290–3.CrossRefGoogle Scholar
  61. 61.
    Tranoulis A, Laios A, Mitsopoulos V, Lutchman-Singh K, Thomakos N. Efficacy of 5% imiquimod for the treatment of Vaginal intraepithelial neoplasia-A systematic review of the literature and a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017;218:129–36. Scholar
  62. 62.
    Caglar H, Hertzog RW, Hreshchyshyn MM. Topical 5-fluorouracil treatment of vaginal intraepithelial neoplasia. Obstet Gynecol. 1981;58(5):580–3.PubMedGoogle Scholar
  63. 63.
    Woodruff JD, Parmley TH, Julian CG. Topical 5-fluorouracil in the treatment of vaginal carcinoma-in-situ. Gynecol Oncol. 1975;3(2):124–32.CrossRefGoogle Scholar
  64. 64.
    Krebs HB, Helmkamp BF. Chronic ulcerations following topical therapy with 5-fluorouracil for vaginal human papillomavirus-associated lesions. Obstet Gynecol. 1991;78(2):205–8.PubMedGoogle Scholar
  65. 65.
    Dungar CF, Wilkinson EJ. Vaginal columnar cell metaplasia. An acquired adenosis associated with topical 5-fluorouracil therapy. J Reprod Med. 1995;40(5):361–6.PubMedGoogle Scholar
  66. 66.
    Godley MJ, Bradbeer CS, Gellan M, Thin RN. Cryotherapy compared with trichloroacetic acid in treating genital warts. Genitourin Med. 1987;63(6):390–2.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Malviya VK, Deppe G, Pluszczynski R, Boike G. Trichloroacetic acid in the treatment of human papillomavirus infection of the cervix without associated dysplasia. Obstet Gynecol. 1987;70(1):72–4.PubMedGoogle Scholar
  68. 68.
    Lin H, Huang EY, Chang HY, ChangChien CC. Therapeutic effect of topical applications of trichloroacetic acid for vaginal intraepithelial neoplasia after hysterectomy. Jpn J Clin Oncol. 2005;35(11):651–4. Scholar
  69. 69.
    Rhodes HE, Chenevert L, Munsell M. Vaginal intraepithelial neoplasia (VaIN 2/3): comparing clinical outcomes of treatment with intravaginal estrogen. J Low Genit Tract Dis. 2014;18(2):115–21. Scholar
  70. 70.
    Ogino I, Kitamura T, Okajima H, Matsubara S. High-dose-rate intracavitary brachytherapy in the management of cervical and vaginal intraepithelial neoplasia. Int J Radiat Oncol Biol Phys. 1998;40(4):881–7.CrossRefGoogle Scholar
  71. 71.
    Liao JB, Jean S, Wilkinson-Ryan I, Ford AE, Tanyi JL, Hagemann AR, et al. Vaginal intraepithelial neoplasia (VAIN) after radiation therapy for gynecologic malignancies: a clinically recalcitrant entity. Gynecol Oncol. 2011;120(1):108–12. Scholar
  72. 72.
    Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM, Perez G, Koutsky LA, et al. Efficacy of a quadrivalent prophylactic human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet. 2007;369(9574):1693–702. Scholar
  73. 73.
    Dillner J, Kjaer SK, Wheeler CM, Sigurdsson K, Iversen OE, Hernandez-Avila M, et al. Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial. BMJ. 2010;341:c3493. Scholar
  74. 74.
    Nelson EL, Stockdale CK. Vulvar and vaginal HPV disease. Obstet Gynecol Clin North Am. 2013;40(2):359–76. Scholar
  75. 75.
    Cheng D, Ng TY, Ngan HY, Wong LC. Wide local excision (WLE) for vaginal intraepithelial neoplasia (VAIN). Acta Obstet Gynecol Scand. 1999;78(7):648–52.CrossRefGoogle Scholar
  76. 76.
    Choi YJ, Hur SY, Park JS, Lee KH. Laparoscopic upper vaginectomy for post-hysterectomy high risk vaginal intraepithelial neoplasia and superficially invasive vaginal carcinoma. World J Surg Oncol. 2013;11:126. Scholar
  77. 77.
    Luyten A, Hastor H, Vasileva T, Zander M, Petry KU. Laser-skinning colpectomy for extended vaginal intraepithelial neoplasia and microinvasive cancer. Gynecol Oncol. 2014;135(2):217–22. Scholar
  78. 78.
    Krebs HB. Treatment of vaginal intraepithelial neoplasia with laser and topical 5-fluorouracil. Obstet Gynecol. 1989;73(4):657–60.PubMedGoogle Scholar
  79. 79.
    Hoffman MS, Roberts WS, LaPolla JP, Fiorica JV, Cavanagh D. Laser vaporization of grade 3 vaginal intraepithelial neoplasia. Am J Obstet Gynecol. 1991;165(5 Pt 1):1342–4.CrossRefGoogle Scholar
  80. 80.
    Diakomanolis E, Rodolakis A, Sakellaropoulos G, Kalpaktsoglou K, Aravantinos D. Conservative management of vaginal intraepithelial neoplasia (VAIN) by laser CO2. Eur J Gynaecol Oncol. 1996;17(5):389–92.PubMedGoogle Scholar
  81. 81.
    Campagnutta E, Parin A, De Piero G, Giorda G, Gallo A, Scarabelli C. Treatment of vaginal intraepithelial neoplasia (VAIN) with the carbon dioxide laser. Clin Exp Obstet Gynecol. 1999;26(2):127–30.PubMedGoogle Scholar
  82. 82.
    Perrotta M, Marchitelli CE, Velazco AF, Tauscher P, Lopez G, Peremateu MS. Use of CO2 laser vaporization for the treatment of high-grade vaginal intraepithelial neoplasia. J Low Genit Tract Dis. 2013;17(1):23–7. Scholar
  83. 83.
    Wang Y, Kong WM, Wu YM, Wang JD, Zhang WY. Therapeutic effect of laser vaporization for vaginal intraepithelial neoplasia following hysterectomy due to premalignant and malignant lesions. J Obstet Gynaecol Res. 2014;40(6):1740–7. Scholar
  84. 84.
    Piovano E, Macchi C, Attamante L, Fuso L, Maina G, Pasero L, et al. CO2 laser vaporization for the treatment of vaginal intraepithelial neoplasia: effectiveness and predictive factors for recurrence. Eur J Gynaecol Oncol. 2015;36(4):383–8.PubMedGoogle Scholar
  85. 85.
    Kirwan P, Naftalin NJ. Topical 5-fluorouracil in the treatment of vaginal intraepithelial neoplasia. Br J Obstet Gynaecol. 1985;92(3):287–91.CrossRefGoogle Scholar
  86. 86.
    Murta EF, Neves Junior MA, Sempionato LR, Costa MC, Maluf PJ. Vaginal intraepithelial neoplasia: clinical-therapeutic analysis of 33 cases. Arch Gynecol Obstet. 2005;272(4):261–4. Scholar
  87. 87.
    Fiascone S, Vitonis AF, Feldman S. Topical 5-fluorouracil for women with high-grade vaginal intraepithelial neoplasia. Obstet Gynecol. 2017;130(6):1237–43. Scholar
  88. 88.
    Woodman CB, Mould JJ, Jordan JA. Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy. Br J Obstet Gynaecol. 1988;95(10):976–9.CrossRefGoogle Scholar
  89. 89.
    MacLeod C, Fowler A, Dalrymple C, Atkinson K, Elliott P, Carter J. High-dose-rate brachytherapy in the management of high-grade intraepithelial neoplasia of the vagina. Gynecol Oncol. 1997;65(1):74–7. Scholar
  90. 90.
    Teruya Y, Sakumoto K, Moromizato H, Toita T, Ogawa K, Murayama S, et al. High dose-rate intracavitary brachytherapy for carcinoma in situ of the vagina occurring after hysterectomy: a rational prescription of radiation dose. Am J Obstet Gynecol. 2002;187(2):360–4.CrossRefGoogle Scholar
  91. 91.
    Graham K, Wright K, Cadwallader B, Reed NS, Symonds RP. 20-year retrospective review of medium dose rate intracavitary brachytherapy in VAIN3. Gynecol Oncol. 2007;106(1):105–11. Scholar
  92. 92.
    Blanchard P, Monnier L, Dumas I, Morice P, Pautier P, Duvillard P, et al. Low-dose-rate definitive brachytherapy for high-grade vaginal intraepithelial neoplasia. Oncologist. 2011;16(2):182–8. Scholar
  93. 93.
    Song JH, Lee JH, Lee JH, Park JS, Hong SH, Jang HS, et al. High-dose-rate brachytherapy for the treatment of vaginal intraepithelial neoplasia. Cancer Res Treat. 2014;46(1):74–80. Scholar
  94. 94.
    Zolciak-Siwinska A, Gruszczynska E, Jonska-Gmyrek J, Kulik A, Michalski W. Brachytherapy for vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2015;194:73–7. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Xingnan Zhou
    • 1
  • Tien Anh Nguyen Tran
    • 2
  • Robert W. Holloway
    • 3
  1. 1.Department of Obstetrics and GynecologyPeking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical SciencesBeijingChina
  2. 2.Department of PathologyFlorida Hospital OrlandoOrlandoUSA
  3. 3.Florida Hospital Gynecologic OncologyOrlandoUSA

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