{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:56:57Z","timestamp":1789649817929,"version":"4.0.0"},"reference-count":24,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: To describe clinical and virologic outcomes after topical 5% imiquimod for VaIN (vaginal intraepithelial neoplasia) within routine clinical practice, including the assessment of available post-treatment high-risk HPV status, and to evaluate its relationship with treatment outcomes. Methods: In this retrospective-cohort study, twenty patients with histologically confirmed VaIN (low-grade VaIN = 10, high-grade VaIN = 10) were evaluated between October 2020 and October 2022. The treatment varied based on the initial VaIN grade. The primary endpoint was complete response, defined as negative cytology and\/or benign follow-up biopsy. Secondary endpoints included partial response (downgrading from high-grade to low-grade), persistence\/progression, adverse events, and available post-treatment high-risk HPV status. Results: Among seventeen evaluable patients, a complete response was observed in 69.2% (9\/13) imiquimod-treated patients. In high-grade VaIN imiquimod-treated patients, complete response was observed in 66.7% (6\/9), while 33.3% (3\/9) downgraded to low-grade VaIN on biopsy as a secondary outcome, with no persistence over a median follow-up of 24 months. Low-grade VaIN showed 75% clearance with either imiquimod or observation at a median follow-up of 24 months. In one low-grade imiquimod-treated, persistent HPV16 was observed, and the lesion progressed to high-grade VaIN; however, no invasive cancers were observed during follow-up. Adverse events related to imiquimod were mild; there were no discontinuations. Among baseline high-risk HPV positive imiquimod-treated patients, post-treatment follow-up HPV testing was available in a limited subset group, and clearance was confirmed in 44% (4\/9) among those with follow-up testing and presented descriptively as exploratory. Conclusions: In this single-center retrospective cohort, outcomes after topical 5% imiquimod are reported as observed findings. Complete and partial responses were observed in high-grade VaIN with acceptable tolerability and no invasive events at available intermediate follow-up (median 24 months). Post-treatment HPV testing provided complementary virologic information alongside clinical outcomes, consistent with recommendations incorporating HPV testing into VaIN follow-up, and longer surveillance is required to assess long-term oncologic outcomes.<\/jats:p>","DOI":"10.3390\/jcm15072499","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:11:14Z","timestamp":1774429874000},"page":"2499","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical and Virologic Outcomes of Topical Imiquimod in Vaginal Intraepithelial Neoplasia: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0493-5439","authenticated-orcid":false,"given":"Nazl\u0131 Aylin","family":"Vural","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, Yozgat State Hospital, 66100 Yozgat, Turkey"},{"name":"Molecular Oncology (Master), Graduate School of Education, Istinye University, 34396 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7219-1772","authenticated-orcid":false,"given":"Merve","family":"Ald\u0131ka\u00e7t\u0131o\u011flu Talma\u00e7","sequence":"additional","affiliation":[{"name":"Molecular Oncology (Master), Graduate School of Education, Istinye University, 34396 Istanbul, Turkey"},{"name":"Department of Gynecologic Oncology, Kanuni Sultan Suleyman Training and Research Hospital, Health Sciences University, 34668 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5650-5998","authenticated-orcid":false,"given":"\u0130zel","family":"G\u00fcnay","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Basaksehir Cam and Sakura State Hospital, Health Sciences University, 34668 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7337-9977","authenticated-orcid":false,"given":"\u0130lkbal","family":"Temel Y\u00fcksel","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Basaksehir Cam and Sakura State Hospital, Health Sciences University, 34668 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gazi","family":"G\u00fcner","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Basaksehir Cam and Sakura State Hospital, Health Sciences University, 34668 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2047-548X","authenticated-orcid":false,"given":"Emel","family":"Canaz","sequence":"additional","affiliation":[{"name":"Department of Gynecology with Center for Oncological Surgery, European Comprehensive Center for Ovarian Cancer, Charit\u00e9 Medical University of Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Turan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mersin City Hospital, University of Health Sciences, 33240 Mersin, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baki","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Ac\u0131badem University Hospital, 34140 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9183-3558","authenticated-orcid":false,"given":"Nil\u00fcfer \u00c7etinkaya","family":"Kocadal","sequence":"additional","affiliation":[{"name":"Gynecologic Oncology, Department of Obstetrics and Gynecology, Yeditepe University, 34755 Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1089\/jwh.2009.1570","article-title":"Update of HPV-associated female genital cancers in the United States, 1999\u20132004","volume":"18","author":"Watson","year":"2009","journal-title":"J. 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