Zhang L, Xiao Y P, Tao X, Cao Y K, Sui L, Cong Q
Cervical Disease Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
Zhonghua Fu Chan Ke Za Zhi. 2023 Aug 25;58(8):603-610. doi: 10.3760/cma.j.cn112141-20230607-00255.
To explore the detection rate, clinical characteristics of vulvar squamous intraepithelial lesion (SIL). Women diagnosed with vulvar high-grade squamous intraepithelial lesions (HSIL) through colposcopy-guided biopsy from January 1, 2018 to August 31, 2022 in Obstetrics and Gynecology Hospital of Fudan University were included in a 1∶1 ratio with patients diagnosed with vulvar low-grade squamous intraepithelial lesions (LSIL) during the same period. Clinical characteristics including human papillomavirus (HPV) infection rate, genotype, cytology result, colposcopy impression, and lesion location were retrospectively analyzed. (1) The proportion of vulvar SIL detected by colposcopy-guided biopsy increased annually from 2018 to 2022, with rates of 1.64% (740/45 057), 2.34% (1 110/47 402), 2.68% (1 108/41 335), 3.26% (1 536/47 078), 3.31% (667/20 155), with an average rate of 2.57% (5 161/201 027). (2) A total of 1 096 cases of vulvar HSIL and 1 096 cases of vulvar LSIL were included. The overall infection rate of HPV was 92.7% (1 993/2 150), with higher infection rate in vulvar HSIL patients than that in vulvar LSIL patients [96.0% (1 012/1 054) vs 89.5% (981/1 096); =33.62, <0.001]. Among vulvar HSIL patients, the common HPV genotype from high to low were HPV 16 (66.7%), HPV 52 (14.3%), and HPV 58 (10.0%). For vulvar LSIL patients, the most common HPV genotype were respectively HPV 16 (24.9%), HPV 6 (20.1%) and HPV 52 (17.1%). The overall sensitivity rate of cytology was 53.6%, with no significance difference between vulvar LSIL and HSIL groups (54.3% vs 52.9%; =0.40, =0.526). The accuracy of colposcopy impression for vulvar HSIL was lower than that for vulvar LSIL [40.2% (163/405) vs 81.7% (380/465); =158.72, <0.001]. About 57.3% (1 257/2 192) of the patients had concomitant cervical and vaginal lesions, with a higher rate in vulvar HSIL group than that in vulvar LSIL group [62.6% (686/1 096) vs 52.1% (571/1 096); =24.67, <0.001]. Unifocal lesion was the main type, with no significance difference between vulvar LSIL and HSIL groups [81.4% (381/468) vs 82.5% (386/468); =0.18, =0.671]. The most common lesion locations were the posterior commissure, followed by labia minora, vaginal vestibule, labia majora, perianal and clitoris. The detection rate of vulvar SIL under colposcopy is about 3%, and the infection rate of HPV is 92.7%. Vulvar SIL, especially vulvar HSIL, is likely to cause concomitant cervical and vaginal lesions. The accuracy of colposcopy in diagnosing vulvar HSIL is low. Therefore a comprehensive and careful examination of the vulva is necessary and suspicious vulvar lesions should be undergone colposcopy-guided biopsy for diagnosis.
探讨外阴鳞状上皮内病变（SIL）的检出率及临床特征。选取2018年1月1日至2022年8月31日在复旦大学附属妇产科医院经阴道镜引导下活检诊断为外阴高级别鳞状上皮内病变（HSIL）的患者，与同期诊断为外阴低级别鳞状上皮内病变（LSIL）的患者按1∶1比例纳入研究。回顾性分析其临床特征，包括人乳头瘤病毒（HPV）感染率、基因型、细胞学结果、阴道镜印象及病变部位。（1）2018 - 2022年经阴道镜引导下活检检出的外阴SIL比例逐年上升，分别为1.64%（740/45 057）、2.34%（1 110/47 402）、2.68%（1 108/41 335）、3.26%（1 536/47 078）、3.31%（667/20 155），平均检出率为2.57%（5 161/201 027）。（2）共纳入1 096例外阴HSIL和1 096例外阴LSIL患者。HPV总体感染率为92.7%（1 993/2 150），外阴HSIL患者感染率高于外阴LSIL患者[96.0%（l 012/1 054）比89.5%（981/1 096）；χ² =33.62，P<0.001]。外阴HSIL患者中，常见HPV基因型由高到低依次为HPV 16（66.7%）、HPV 52（14.3%）、HPV 58（10.0%）。外阴LSIL患者中，最常见的HPV基因型分别为HPV 16（24.9%）、HPV 6（20.1%）和HPV 52（17.1%）。细胞学总体敏感度为53.6%，外阴LSIL组与HSIL组差异无统计学意义（分别为54.3%和52.9%；χ² =0.40，P =0.526）。阴道镜对外阴HSIL诊断的准确性低于外阴LSIL[40.2%（163/405）比81.7%（380/465）；χ² =158.72，P<0.001]。约57.3%（1 257/2 192）的患者合并有宫颈和阴道病变，外阴HSIL组高于外阴LSIL组[62.6%（686/1 096）比52.1%（571/1 096）；χ² =24.67，P<0.001]。单病灶病变为主，外阴LSIL组与HSIL组差异无统计学意义[81.4%（381/468）比82.5%（386/468）；χ² =0.18，P =0.671]。最常见的病变部位为后联合，其次为小阴唇、阴道前庭、大阴唇、肛周及阴蒂。阴道镜下外阴SIL的检出率约为3%，HPV感染率为92.7%。外阴SIL尤其是外阴HSIL易合并宫颈和阴道病变。阴道镜诊断外阴HSIL的准确性低。因此，对外阴进行全面细致的检查很有必要，对外阴可疑病变应行阴道镜引导下活检以明确诊断。
