Benedet J L, Wilson P S, Matisic J
Division of Gynaecologic Oncology, Cancer Control Agency of British Columbia, Vancouver, Canada.
J Reprod Med. 1991 Aug;36(8):608-12.
Colposcopically directed biopsies obtained from 165 women with vulvar intraepithelial neoplasia (VIN) were studied to determine both the thickness of the dysplastic epithelium and the depth of involved and noninvolved skin appendages and ultimately to provide a morphometric basis for laser therapy for the condition. Multiple measurements per section were made, and the mean epithelial thickness was calculated for each biopsy. The mean (+/- SD) thickness of the epithelium for all grades of VIN was 0.52 +/- 0.23 mm, with the lesions ranging in thickness from 0.10 to 1.90 mm. The thickness of the involved epithelium varied little, regardless of the location of the lesions. The study indicated that VIN frequently is a multifocal disease most commonly affecting the central vulvar structures, with the posterior half of the vulva the area affected most often. The difference in thickness between the various grades of VIN was not of practical clinical significance from a therapeutic point of view. The measurements suggest that laser vaporization to a depth of 1.0 mm, including the zone of thermal necrosis, should be sufficient to destroy most epidermal lesions without skin appendage involvement. If the initial biopsy showed involvement of adjacent hair follicles or sebaceous glands, deeper tissue destruction would be necessary to theoretically achieve greater than 90% elimination of the disease.
对165例患有外阴上皮内瘤变（VIN）的女性进行了阴道镜引导下活检，以确定发育异常上皮的厚度以及受累和未受累皮肤附属器的深度，并最终为该疾病的激光治疗提供形态学依据。对每个切片进行多次测量，并计算每个活检样本的平均上皮厚度。所有等级VIN的上皮平均（±标准差）厚度为0.52±0.23mm，病变厚度范围为0.10至1.90mm。无论病变位于何处，受累上皮的厚度变化不大。该研究表明，VIN通常是一种多灶性疾病，最常影响外阴中央结构，外阴后半部是最常受累的区域。从治疗角度来看，不同等级VIN之间的厚度差异没有实际临床意义。测量结果表明，激光汽化至1.0mm深度，包括热坏死区，应足以破坏大多数无皮肤附属器受累的表皮病变。如果初始活检显示相邻毛囊或皮脂腺受累，理论上需要更深的组织破坏才能实现超过90%的疾病清除率。
