Multizonal intraepithelial neoplasia (MUZIN) of the lower genital tract:a descriptive review of the management of women with MUZIN at a singleinstitution

Abstract

Background: Multizonal intraepithelial neoplasia (MUZIN) of the lower genital tract occurs when women present with more than one intraepithelial neoplasia lesion associated with human papilloma virus (HPV). This study reviews the management of women diagnosed with MUZIN at Groote Schuur Hospital (GSH) in 2018.

Methods: A retrospective analysis of 104 women diagnosed with MUZIN at the colposcopy clinic was performed. Patient demographics, disease areas, management, histology, follow-up, and recurrences were recorded.

Results: In 2018, 653 women attended the colposcopy clinic at GSH. Of these, 104 women had evidence of MUZIN, providing an incidence of 16%. A total of 90 folders were analysed. Multiple anatomical areas were affected, with the cervix and vulva as the most frequent combination (n = 26, 28.9%). Initial management of women with MUZIN was as outpatients (n = 46, 51.1%), as inpatients (n = 16, 17.8%), or as out- and inpatients (n = 23, 25.6%). Large loop excision of the transformation zone (LLETZ) was the most common outpatient procedure (45.6%), and vulval excision was the most common inpatient procedure (14.4%). Of the 72 histological specimens, 58 (80.6%) were premalignant, and 13 (18%) were malignant. Of the women, 16 had recurrences, and 64.4% were lost to follow-up.

Conclusion: Multiple procedures are often needed, and long-term follow-up is imperative to diagnose and treat recurrences. In this study, we acknowledge that many women may have been lost to follow-up due to the COVID-19 pandemic.