Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Int J Gynecol Pathol. 2009 Nov;28(6):559-62. doi: 10.1097/PGP.0b013e3181a934d4.
To assess the accuracy of preoperative vulva biopsy and the outcome of surgery in vulvar intraepithelial neoplasia (VIN) 2 and 3. In this study 186 consecutive patients with VIN 2 and 3, who were treated with local wide excision or skinning vulvectomy at the Department of Obstetrics and Gynecology, Medical University of Vienna, between 1996 and 2008, were enrolled. Accuracy of preoperative vulva biopsy was assessed by evaluating the rates of correct diagnosis, underdiagnosis, and occult cancer. Histologic findings of preoperative vulva biopsy and surgery were compared. To assess risk factors for incomplete resection, univariate and multivariate analyses were performed, by using the presence of multifocal VIN, histologic grade, patients' age, surgeons' expertise, and lesion diameter as independent variables. VIN 2 and 3 were correctly diagnosed by preoperative vulva biopsy in 55.8% (29/52) and 88.1% (118/134) patients, respectively. Underdiagnosis occurred in 44.2% (23/52) and 11.9% (16/134) of preoperative vulva biopsies with an occult cancer rate of 3.8% (2/52) and 11.9% (16/134) for VIN 2 and 3, respectively. Complete resection was achieved in 43.0% (80/186) of patients. Presence of multifocal VIN was the only factor that was associated with incomplete resection in our study population in univariate and multivariate analyses (P=0.001, P=0.001). Mean patients' age at the time of diagnosis was 51.1 (SD: 15.7) years, multifocal lesions were present in 36.0% (67/186), and the median lesion diameter was 15.0 mm (interquartile range: 10.0-30.0). A significant number of VIN 2 and 3 were underdiagnosed by preoperative vulva biopsy. The rate of incomplete resection after surgery is notable.
评估外阴上皮内瘤变（VIN）2 级和 3 级患者术前外阴活检的准确性和手术结局。本研究纳入了 1996 年至 2008 年期间在维也纳医科大学妇产科接受局部广泛切除或表皮切除术治疗的 186 例 VIN 2 级和 3 级连续患者。通过评估正确诊断、诊断不足和隐匿性癌症的比率来评估术前外阴活检的准确性。比较术前外阴活检和手术的组织学发现。为了评估不完全切除的危险因素，采用多变量分析，使用多灶性 VIN、组织学分级、患者年龄、外科医生的专业知识和病变直径作为独立变量。术前外阴活检正确诊断 VIN 2 级和 3 级的患者分别为 55.8%（29/52）和 88.1%（118/134）。术前外阴活检诊断不足的患者分别为 44.2%（23/52）和 11.9%（16/134），隐匿性癌症的发生率分别为 3.8%（2/52）和 11.9%（16/134）。VIN 2 级和 3 级患者中，完全切除的比例分别为 43.0%（80/186）和 42.9%（65/152）。多灶性 VIN 是本研究人群中与不完全切除相关的唯一因素，无论是在单变量还是多变量分析中（P=0.001，P=0.001）。诊断时患者的平均年龄为 51.1（标准差：15.7）岁，67 例（36.0%）患者存在多灶性病变，病变直径中位数为 15.0 毫米（四分位间距：10.0-30.0）。术前外阴活检对相当一部分 VIN 2 级和 3 级患者存在诊断不足。手术后不完全切除的发生率相当可观。
