Sarkar Anjali, Bhaskaran Sruthi, Suneja Amita, Singal Archana, Sharma Sonal
Department of Obstetrics & Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, 110095 India.
Department of Dermatology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, 110095 India.
J Obstet Gynaecol India. 2024 Dec;74(6):505-512. doi: 10.1007/s13224-023-01934-w. Epub 2024 Mar 13.
TRIV is a new and promising technique based on the fact that Vulva can be divided into three circular zones based on anatomy, embryology, and histology- Outer, Middle, and Inner ring. The Vulvoscopy Index and N-S-P scheme are objective tools to improve the systematization of vulvoscopy findings and to simplify information management using TRIV.
Hundred women with vulvar complaints (Cases) and 100 asymptomatic women (Controls) underwent TRIV and findings were documented as per N-S-P Scheme and Vulvoscopy Index. Biopsy was taken from specific lesions. Vulvar disorders were categorized into 5 categories based on histology and clinical findings-Vulvodynia, Impaired vulvar skin, Vulvar dermatosis, pre-malignant lesions of the vulva, and others.
According to N-S-P scheme most common formulas were- N-N-N for Normal vulva, P-P-P for vulvar dermatoses, and N-S-N for Impaired Vulvar skin. The mean Vulvoscopy index was 4.33 ± 0.52 for Impaired vulvar skin, 6.11 ± 2.87 for vulvodynia, 24 ± 6.04 for pre-malignant lesions of vulva, and 25.17 ± 4.31 for vulvar dermatosis. The sensitivity, specificity, and diagnostic accuracy of the Vulvoscopy Index for detecting vulvar disorders were 100%, 96.51%, and 98.50%, respectively. The positive and negative predictive values were 0.97 and 1.00, respectively.
The Vulvoscopy Index is a significant predictor for vulvar disorders. N-S-P scheme helps in the objective and systematic documentation of TRIV findings, which allows monitoring of the vulvar changes. TRIV can be used for preventing early stages of vulvar dermatosis which is a risk factor for vulvar malignancy.
TRIV是一种新的且有前景的技术，其基于外阴可根据解剖学、胚胎学和组织学分为三个环形区域这一事实，即外环、中环和内环。外阴镜检查指数和N-S-P方案是客观工具，可提高外阴镜检查结果的系统化程度，并使用TRIV简化信息管理。
100名有外阴不适的女性（病例组）和100名无症状女性（对照组）接受了TRIV检查，并根据N-S-P方案和外阴镜检查指数记录结果。从特定病变处取活检。根据组织学和临床发现，外阴疾病分为5类——外阴痛、外阴皮肤受损、外阴皮肤病、外阴癌前病变和其他。
根据N-S-P方案，最常见的模式为：正常外阴为N-N-N，外阴皮肤病为P-P-P，外阴皮肤受损为N-S-N。外阴皮肤受损的平均外阴镜检查指数为4.33±0.52，外阴痛为6.11±2.87，外阴癌前病变为24±6.04，外阴皮肤病为25.17±4.31。外阴镜检查指数检测外阴疾病的敏感性、特异性和诊断准确性分别为100%、96.51%和98.50%。阳性和阴性预测值分别为0.97和1.00。
外阴镜检查指数是外阴疾病的重要预测指标。N-S-P方案有助于对外阴镜检查结果进行客观、系统的记录，从而能够监测外阴变化。TRIV可用于预防外阴皮肤病的早期阶段，而外阴皮肤病是外阴恶性肿瘤的危险因素。
