Zhang Lu, Wang Qing, Zhang Hongwei, Xie Yu, Sui Long, Cong Qing
Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China.
Cancer Manag Res. 2021 Nov 26;13:8855-8863. doi: 10.2147/CMAR.S335701. eCollection 2021.
To examine the screening history of vaginal intraepithelial neoplasia (VaIN) and vaginal cancer.
We included women with histologically confirmed VaIN or vaginal cancer by colposcopy-directed biopsy between 1 January 2019 and 31 December 2019. The results of cytology, hrHPV, colposcopic examination and history of hysterectomy were retrospectively analysed.
A total of 26,432 colposcopies were performed during the study period, among which 2131 women (1835 [86.1%] with VaIN 1; 268 [12.6%] with VaIN 2/3; and 28 [1.3%] with vaginal cancer) were retrospectively studied. hrHPV test positivity was significantly higher than that of cytology for VaIN 1 (84.4% vs 67.3%; P < 0.001) and VaIN 2/3 (92.0% vs 79.9%; P < 0.001) but not for vaginal cancer (84.6% vs 78.6%; P = 0.73). Additionally, the concordance rates for colposcopic impression were 79.5%, 54.5%, and 92.8% for VaIN1, VaIN2/3, and vaginal cancer, respectively. All 372 patients had a history of hysterectomy, and 81.0% (282/348) of indications were related to cervical precancer and cancer. Although cytology test positivity was significantly higher in patients with hysterectomy than in patients without hysterectomy (76.2% vs 67.5%; P < 0.001), cytology combined with hrHPV can help to detect more than 95% of VaIN and vaginal cancer cases in both groups (96.2% for patients with hysterectomy and 96.5% for patients without hysterectomy).
VaIN and vaginal cancer are not rare diseases. Although cytology was sensitive (67.5%-76.2%) for detecting vaginal lesions regardless of hysterectomy, cytology combined with hrHPV improves detection accuracy up to 95% in both groups.
研究阴道上皮内瘤变（VaIN）和阴道癌的筛查史。
我们纳入了2019年1月1日至2019年12月31日期间经阴道镜引导活检组织学确诊为VaIN或阴道癌的女性。回顾性分析细胞学、高危型人乳头瘤病毒（hrHPV）、阴道镜检查结果及子宫切除术史。
研究期间共进行了26432次阴道镜检查，其中对2131名女性进行了回顾性研究（1835例[86.1%]为VaIN 1；268例[12.6%]为VaIN 2/3；28例[1.3%]为阴道癌）。VaIN 1（84.4%对67.3%；P<0.001）和VaIN 2/3（92.0%对79.9%；P<0.001）的hrHPV检测阳性率显著高于细胞学检测阳性率，但阴道癌（84.6%对78.6%；P = 0.73）并非如此。此外，VaIN1、VaIN2/3和阴道癌的阴道镜印象符合率分别为79.5%、54.5%和92.8%。所有372例患者均有子宫切除术史，81.0%（282/348）的手术指征与宫颈上皮内瘤变和癌症有关。虽然子宫切除术后患者的细胞学检测阳性率显著高于未进行子宫切除术的患者（76.2%对67.5%；P<0.001），但细胞学联合hrHPV可帮助两组中检测出超过95%的VaIN和阴道癌病例（子宫切除术后患者为96.2%，未进行子宫切除术的患者为96.5%）。
VaIN和阴道癌并非罕见疾病。尽管无论是否进行子宫切除术，细胞学对检测阴道病变均敏感（67.5%-76.2%），但细胞学联合hrHPV可使两组的检测准确率提高至95%。
