Use of Radiofrequency (LEEP) in the Treatment of Vaginal Intraepithelial Neoplasia (VaIN)

Abstract

Vaginal intraepithelial neoplasia (VaIN) is a rare condition. It is associated with persistent HPV infection, particularly type 16, and with a history of cervical intraepithelial neoplasia (CIN) or cervical cancer, especially in women who underwent hysterectomy. While most VaIN1 lesions show spontaneous regression, VaIN2/3 require treatment to prevent progression to invasive carcinoma, estimated at 2–7%. This narrative review analyzed clinical studies evaluating the use of the loop electrosurgical excision procedure (LEEP) in the treatment of VaIN, including data from the series by Terzakis, Massad, Chen, and Cui, as well as international guidelines: European Society of Gynecological Oncology (ESGO), International Society for the Study of Vulvovaginal Disease (ISSVD), European College for the Study of Vulval Disease (ECSVD), and European Federation of Colposcopy (EFC). Findings indicate that LEEP shows cure rates ranging from 62 to 100%, with recurrence rates between 25% and 37%. Key results include: Terzakis’ series, 75% complete response at 12 months; Massad’s study, total remission in VaIN 2 and LSIL regression in VaIN 3; Chen’s series, excisional techniques superior to topical therapies; and Cui’s study, 99% of lesions ≤1 mm in thickness, supporting the need for shallow and precise excision. LEEP is an effective and safe option for treating unifocal or clustered VaIN2/3, particularly at the vaginal vault following hysterectomy. Its main advantage is the ability to provide a histological assessment of margins, ensuring the exclusion of microinvasion. However, it should be avoided in extensive multifocal cases or in atrophic mucosa, where the CO₂ laser may be more suitable. Careful patient selection and technical expertise are essential to minimize complications and optimize outcomes.