Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitaetsstrasse 21-23, 91054, Erlangen, Germany.
Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Krankenhausstraße 8-10, 91054, Erlangen, Germany.
Arch Gynecol Obstet. 2020 Mar;301(3):769-777. doi: 10.1007/s00404-020-05441-5. Epub 2020 Jan 28.
Malignancies of the vagina are rare, but colposcopy-directed biopsies play a major role in detecting vaginal intraepithelial lesions. Data of accuracy in detecting neoplasia of the vagina are very rare compared to accuracy in detecting cervical neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with clinical findings of the examiner.
The accuracy of colposcopy-directed biopsy was compared with the clinical finding in relation to the patient's age and the examiner's level of training. This was done in combination with PAP-smear, HPV-test results, and the history of other malignancies of the lower genital tract. The data were collected between January 2014 and February 2018 at the certified Dysplasia Unit of the University Hospital Erlangen.
In total, 253 biopsies from 253 women from the vagina were obtained. The overall accuracy of biopsy in comparison with clinical finding was 52.17% for all entities-benign lesions, low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs), and vaginal carcinoma. The accuracy for detecting HSIL was 82.46% (47/57), with an underdiagnosis rate of 15.79% and an overdiagnosis rate of 1.79%.
With a sensitivity of over 80%, colposcopy-directed biopsy plays an important role in detecting vaginal-HSIL. A highly experienced practitioner is increasing the sensitivity in detecting vaginal-HSIL. Careful examination is required in women with a history of HSIL of the lower genital tract or with simultaneous neoplasia because they are of greater risk of developing vaginal malignancies. The combination of careful clinical work up, PAP-smear, HPV-testing, and colposcopy-guided biopsy is crucial in detecting vaginal-HSIL.
阴道恶性肿瘤较为罕见，但阴道镜指导下活检在发现阴道上皮内病变方面发挥着重要作用。与宫颈癌相比，阴道肿瘤的检测准确性数据非常罕见。本研究旨在评估阴道镜指导下活检与检查者临床发现的准确性。
将阴道镜指导下活检的准确性与患者年龄和检查者的培训水平相关的临床发现进行比较。这是结合 PAP 涂片、HPV 检测结果以及下生殖道其他恶性肿瘤的病史进行的。数据收集时间为 2014 年 1 月至 2018 年 2 月，在埃尔朗根大学医院的认证上皮内瘤变科进行。
总共从 253 名阴道病变的女性中获得了 253 个活检。所有实体病变的活检与临床发现的总准确率为 52.17%，包括良性病变、低级别鳞状上皮内病变（LSIL）、高级别鳞状上皮内病变（HSIL）和阴道癌。HSIL 的检出准确率为 82.46%（47/57），漏诊率为 15.79%，误诊率为 1.79%。
阴道镜指导下活检的敏感性超过 80%，在检测阴道 HSIL 方面发挥着重要作用。经验丰富的医生可以提高检测阴道 HSIL 的敏感性。对于下生殖道 HSIL 病史或同时存在肿瘤的女性，需要进行仔细的检查，因为她们发生阴道恶性肿瘤的风险更高。仔细的临床检查、PAP 涂片、HPV 检测和阴道镜指导下活检的结合对于检测阴道 HSIL 至关重要。
