Carbon dioxide laser surgery in a therapy protocol using staging for lower female genital tract syndrome

The area of intraepithelial lesions is currently considered to be an important factor in prognosis for the evolution ofthe lesions and for the response to treatment. The association of lesions of different grades within abnormal coiposcopic fmdmgs also makes both the diagnosis and the choice of treatment as well as the evaluation of their results that much more difficult (1 4). To the colposcopic examination is ascribed the important task of diagnosing the topographic extent of the lesions and identifying the histological grade, by means of specific biopsies according to the criteria that constitute colposcopic grading. Colposcopy, considered as a high-responsibility diagnostic test and thus subject to quality control procedures, is therefore a fundamental element in management and therapy protocols (5, 6) that, at the same level of effectiveness, are designed to preserve the organ in terms of: a) sexual and reproductive functions in women with mtraepitheial neoplasia, b) the effectiveness of the cytocolposcopic follow-up. The success rate obtained by different therapy techniques is closely linked to the quality of the original diagnosis as well as the surgical skill arid methods used. The topographic extent of the intraepitheial lesion in the female lower genital tract has, in the literature of the past 1 5 years, always been differentiated according to the organ involved (cervical intraepithelial neoplasia (CIN), vaginal intraepithelial neoplasia (VAIN), vulvar intraepithelial neoplasia (yIN)). The contemporaneous presence and association of the lesions (lower genital tract neoplastic syndrome) (7, 8) requires a further rationalization, in the experience ofthe authors (9, 10), in order for the characteristics of the single therapies to be fully understood and to advance research into treatment that meets the objective of preserving the functions of the organ while ensuring the same level of efficiency in therapy.