阴道上皮内瘤变的临床病理研究。

A clinicopathologic study of vaginal intraepithelial neoplasia.

机构信息

Uniformed Services Residency in Obstetrics and Gynecology and the Division of Gynecological Oncology, Department of Obstetrics and Gynecology, and the Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland.

出版信息

Obstet Gynecol. 2013 Dec;122(6):1223-30. doi: 10.1097/01.AOG.0000435450.08980.de.

DOI:10.1097/01.AOG.0000435450.08980.de

PMID:24201676

Abstract

OBJECTIVE

To evaluate the natural history of vaginal intraepithelial neoplasia (VAIN) and to identify risk factors for invasive vaginal carcinoma.

METHODS

The records of all women with VAIN diagnosed at military treatment facilities over a 10-year period with minimum follow-up of 12 months were reviewed. Patient demographics and clinical information related to the diagnosis and treatment of VAIN were recorded.

RESULTS

One hundred twenty-seven women with VAIN met inclusion criteria. The mean age was 47.4 years, and median surveillance was 34 months (range 12-169 months). Seventy-five patients had low-grade vaginal dysplasia as their initial diagnosis, and 15 (20%) of these patients underwent treatment. Fifty-two patients had high-grade vaginal dysplasia, of which 38 (73%) underwent treatment. Overall, 113 patients (89%) demonstrated normalization of disease, 11 patients (9%) demonstrated persistence of disease, and three patients (2%) experienced recurrence of disease. No patients experienced development of invasive vaginal carcinoma. However, median time to normalization was 6 months longer in patients with low-grade dysplasia compared with those with high-grade dysplasia (15.9 months compared with 10.0 months; hazard ratio 1.5; 95% confidence interval 1.004-2.1; P=.045). Patients with high-grade dysplasia had more biopsies performed during their surveillance than patients with low-grade dysplasia (3.3 compared with 2.5; P=.045).

CONCLUSION

Overall, 89% of patients demonstrated normalization of VAIN, and none had progression to invasive cancer. Normalization, persistence, and recurrence rates did not significantly differ by grade of dysplasia or treatment status. Based on our findings regarding the time to normalization, annual surveillance with combined cytology and colposcopy is likely adequate. Because 11% of patients with VAIN either will experience recurrence or will have persistent disease, lifetime surveillance is recommended.

LEVEL OF EVIDENCE

: III.

摘要

目的

评估阴道上皮内瘤变（VAIN）的自然病史，并确定浸润性阴道癌的危险因素。

方法

回顾了 10 年来在军事治疗设施中诊断为 VAIN 的所有女性患者的记录，这些患者的随访时间至少为 12 个月。记录了与 VAIN 的诊断和治疗相关的患者人口统计学和临床信息。

结果

符合条件的 127 名 VAIN 患者中，平均年龄为 47.4 岁，中位随访时间为 34 个月（范围 12-169 个月）。75 例患者的初始诊断为低级别阴道发育不良，其中 15 例（20%）接受了治疗。52 例患者为高级别阴道发育不良，其中 38 例（73%）接受了治疗。总的来说，113 例（89%）患者疾病正常化，11 例（9%）患者疾病持续存在，3 例（2%）患者疾病复发。无患者发生浸润性阴道癌。然而，低级别发育不良患者的疾病正常化中位时间比高级别发育不良患者长 6 个月（15.9 个月比 10.0 个月；风险比 1.5；95%置信区间 1.004-2.1；P=.045）。在监测期间，高级别发育不良患者的活检次数多于低级别发育不良患者（3.3 次比 2.5 次；P=.045）。