Vulvar intraepithelial neoplasia treated with cavitational ultrasonic surgical aspiration

The aim of the study was to investigate the use of the cavitron ultrasonic surgical aspirator (CUSA) for the treatment of vulvar intraepithelial neoplasia (VIN) as it combines the advantage of laser removal of the superficial dermal layers without scars and the advantage of resection with collection of a pathological specimen.

Between 1992 and 1998, 37 patients with VIN were treated using the CUSA. Charts were reviewed retrospectively.

The median age at diagnosis was 40 years. Eleven patients (30%) had been previously treated for VIN. Diagnosis was made by inspection before and after ascitic acid application, colposcopy, and multiple biopsies revealing VIN II in 8 patients (22%) and VIN III in 29 patients (78%). At least two quadrants of the vulva were involved in 16 cases (43%) and three or four quadrants in 12 cases (33%). Under anesthesia the CUSA was used to remove all lesions with a 1-cm margin. There were no complications except 1 admission for pain control. Healing was complete in 4 to 6 weeks and no patient developed scarring. Final pathology confirmed the preoperative diagnostic grade in 24 cases (65%), while upgrading to a higher dysplasia occurred in 4 patients (11%). A second treatment was necessary in 3 patients with widespread disease. Patients were followed for an average of 33 months. Thirteen recurrences (35%) developed after a median interval of 16 months. Recurrences were significantly (P = 0.004) more frequent if VIN involved hair-bearing tissue, 6 of 7 (86%) cases, in contrast to patients with disease confined to the labia minora and introitus, 7 of 30 (23%) cases.

CUSA is an acceptable treatment alternative for VIN confined to non-hair-bearing vulvar skin.