Monti Ermelinda, Matozzo Cristina Maria Michela, Cetera Giulia Emily, DI Loreto Eugenia, Libutti Giada, Boero Veronica, Caia Carlotta, Alberico Daniela, Barbara Giussy
Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy;
Anticancer Res. 2023 Oct;43(10):4637-4642. doi: 10.21873/anticanres.16658.
BACKGROUND/AIM: Vaginal intraepithelial neoplasia (VaIN) is a rare human papillomavirus (HPV)- related premalignant condition. VaIN lesions are diagnosed histologically through colposcopy-guided biopsies of suspicious areas, conduced by gynecologists with expertise in lower genital tract diseases. The present study aimed to evaluate the accuracy of colposcopy in the diagnosis of VaIN of any grade.
We conducted a retrospective analysis on a cohort of 149 women diagnosed with low grade (LG)-VaIN (VaIN1) and high grade (HG)-VaIN (VaIN2-3) between 2010 and 2022 at the "Regional Referral Center for Prevention, Diagnosis and Treatment of HPV-related Genital Disorders", Ospedale Maggiore Policlinico, Milan, Italy. All women had been referred to our center for an abnormal Pap smear or as part of routine follow-up of other HPV-related diseases and had undergone a vaginal biopsy under colposcopic guidance.
The distribution of the histological grades of VaIN lesions was the following: 62 women (41.6%) were diagnosed with VaIN1, 51 (34.2%) with VaIN2, and 36 (24.2%) with VaIN3. Grade II (major) abnormal colposcopic patterns were recorded in 71 cases (47.7%) and were more commonly observed in women with VaIN3 (80.6%). However, we found a poor and not statistically significant association between colposcopic and histological grade of VaIN. The sensitivity, specificity, positive predictive value, and negative predictive value of colposcopy for histologically confirmed VaIN were 56.3%, 64.5%, 69% and 51.2%, respectively. The overall diagnostic accuracy of colposcopy was 59.7%.
Colposcopy-guided biopsy plays an important role in the diagnosis of VaIN and in the distinction between low and high-grade lesions. Our data show that major colposcopic abnormalities moderately correlate with HG-VaIN and that grade I colposcopic findings do not exclude HG-VaIN, especially VaIN2. Targeted biopsies of suspicious vaginal areas must be performed in all women with an abnormal Pap smear.
背景/目的：阴道上皮内瘤变（VaIN）是一种罕见的与人乳头瘤病毒（HPV）相关的癌前病变。VaIN病变通过阴道镜引导下对可疑区域进行活检，由擅长下生殖道疾病的妇科医生进行组织学诊断。本研究旨在评估阴道镜检查对任何级别的VaIN诊断的准确性。
我们对2010年至2022年间在意大利米兰马焦雷综合医院“HPV相关生殖器疾病区域预防、诊断和治疗转诊中心”诊断为低级别（LG）-VaIN（VaIN1）和高级别（HG）-VaIN（VaIN2-3）的149名女性队列进行了回顾性分析。所有女性均因巴氏涂片异常或作为其他HPV相关疾病常规随访的一部分转诊至我们中心，并在阴道镜引导下进行了阴道活检。
VaIN病变的组织学分级分布如下：62名女性（41.6%）被诊断为VaIN1，51名（34.2%）为VaIN2，36名（24.2%）为VaIN3。71例（47.7%）记录为II级（主要）异常阴道镜模式，在VaIN3女性中更常见（80.6%）。然而，我们发现阴道镜和VaIN组织学分级之间的关联较差且无统计学意义。阴道镜对组织学确诊的VaIN的敏感性、特异性、阳性预测值和阴性预测值分别为56.3%、64.5%、69%和51.2%。阴道镜检查的总体诊断准确性为59.7%。
阴道镜引导下活检在VaIN诊断以及区分低级别和高级别病变中起重要作用。我们的数据表明，主要阴道镜异常与HG-VaIN中度相关，I级阴道镜检查结果不能排除HG-VaIN，尤其是VaIN2。所有巴氏涂片异常的女性都必须对可疑阴道区域进行靶向活检。
