Cavitational ultrasonic surgical aspiration for the treatment of vaginal intraepithelial neoplasia

Objective. The aim of this study is to determine whether cavitational ultra sonic 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 betwee n 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 fr om initial CUSA treatment was 21 months. Twenty-nine patients (63%) were in itially treated with CUSA, 7 patients (15%) with laser vaporization, 7 pati ents (15%) with surveillance by Papanicolaou smear, 1 patient (2%) with par tial vaginectomy, 1 patient (2%) with 5-fluorouracil, and 1 patient (2%) wi th loop excision. Patients initially treated with CUSA had a higher percent age of grade III VAIN at diagnosis (48%) than did patients initially treate d with other methods (29%). A significantly greater proportion of patients initially treated with CUSA had no recurrence of VAIN (66%) compared with p atients initially treated with other methods (0%) (P < 0.0001). A significa ntly greater proportion of patients who were treated for recurrent disease with CUSA had no further recurrence (52%) compared with patients treated fo r recurrent disease with other methods (9%) (P < 0.001). No patient treated with CUSA reported adverse effects; 7 patients treated with other methods reported dysuria, burning, and pain. Conclusion. These initial data suggest that CUSA is a safe and effective me thod for treating VAIN and may be an appropriate treatment for many patient s. (C) 2000 Academic Press.