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Zhang L, Zhang X, Sui L, Cong Q. Risk factors for vaginal squamous intra-epithelial lesions in women with high-grade cervical lesions. Int J Gynecol Cancer 2024; 34:1344-1348. [PMID: 39089729 DOI: 10.1136/ijgc-2024-005531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVE To investigate the high-risk factors associated with concurrent cervical intra-epithelial neoplasia (CIN) and vaginal intra-epithelial neoplasia (VaIN) in patients with high-grade lesions. METHODS This retrospective study at the Obstetrics and Gynecology Hospital of Fudan University included patients diagnosed with concurrent CIN2/3 and VaIN2/3 (concurrent group) over the period from January 1, 2019, to December 31, 2019. Patients with only CIN2/3 during the corresponding period were selected chronologically on a 1:2 basis (CIN group). Demographic data, human papillomavirus (HPV) infection rates, genotypes, and cytology results were compared between the groups. RESULTS A total of 128 patients were included. The median age in the concurrent group was 50 years (range 20-79), which was significantly higher than the median age of 38 (range 23-72) in the CIN group (p<0.001). The cytological sensitivity for identifying high-grade lesions was markedly higher in the concurrent group at 83.1% (103 out of 124) compared with 68.4% (175 out of 256) in the CIN-only group (p=0.002). The prevalence of HPV 16 was 62.8% in the concurrent group, significantly higher than 51.6% in the CIN group (p=0.04). CONCLUSIONS The risk of concurrent VaIN2/3 increases with age among women with CIN2/3. Cytology screening is effective for detecting concurrent VaIN2/3, with a sensitivity of 83.1%.
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Affiliation(s)
- Lu Zhang
- Lower Genital Tract Disease Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
| | - Xiujuan Zhang
- Puyang Oilfield General Hospital, Puyang, Henan, China
| | - Long Sui
- Lower Genital Tract Disease Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
| | - Qing Cong
- Lower Genital Tract Disease Center, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
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Bruno MT, Panella MM, Valenti G, Di Grazia S, Sgalambro F, Farina J, Previti M, Mereu L. Vaginal Intraepithelial Neoplasia (VaIN) after Hysterectomy Is Strongly Associated with Persistent HR-HPV Infection. Cancers (Basel) 2024; 16:2524. [PMID: 39061164 PMCID: PMC11274675 DOI: 10.3390/cancers16142524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
The data from the literature show that women undergoing a LEEP due to CIN3 have a greater risk of having subsequent high-grade anogenital intraepithelial neoplasia or cancer, and the risk is greater for vaginal cancer than for anal and vulvar cancers. It is hypothesized that the laparoscopic hysterectomy procedure may cause a higher incidence of VaIN in hysterectomized women. There are few studies addressing this issue, and they show mixed results. This study aimed to investigate the incidence of high-grade or severe VaIN in the population of women undergoing hysterectomy for CIN3 or benign uterine disease and illustrate the treatment options and follow-up. METHODS This retrospective study was conducted on 170 women who underwent a laparoscopic hysterectomy due to high-grade cervical intraepithelial neoplasia (CIN3) or benign gynecological disease. The follow-up strategy included performing a cotest and colposcopy with biopsy if necessary. The median time between primary treatment and a diagnosis of high-grade VaIN was 18 months. RESULTS High-grade or severe VaIN was found in eight patients after hysterectomy (4.7%). All cases of high-grade VaIN occurred in women with persistent HPV infection. The most frequent genotype was 16. Women hysterectomized due to CIN3 showed an eight-fold greater risk than women hysterectomized due to benign disease of developing high-grade VaIN. The risk of VaIN is low in women hysterectomized due to benign disease. The risk of developing VaIN is greater in women with viral persistence. CONCLUSION All these elements suggest that it is a history of HPV-related disease of the lower genital tract and viral persistence, rather than hysterectomy itself, that should be considered risk factors for the development of high-grade VaIN. After hysterectomy, patients with a history of CIN should undergo annual screening with vaginal dome cytology and HPV testing.
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Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
| | - Marco Marzio Panella
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
| | - Gaetano Valenti
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy;
- Gynaecologic Oncology Unit, Humanitas Hospital, 95126 Catania, Italy
| | - Salvatore Di Grazia
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Francesco Sgalambro
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Jessica Farina
- Anatomic Pathology Unit, Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy;
| | - Miriam Previti
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
| | - Liliana Mereu
- Department of General Surgery and Medical-Surgical Specialty, Gynecology and Obstetrics Unit, Rodolico University Hospital, University of Catania, 95123 Catania, Italy; (M.M.P.); (S.D.G.); (F.S.); (M.P.); (L.M.)
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Wang B, Zhang C, Su Y, Yuan S, Zhou M, Zhang M, Zhou Y, Cao L, Zhang M, Zhang T. Comparative study of topical 5-aminolevulinic acid photodynamic therapy and surgery in treating vaginal high-grade squamous intraepithelial lesions following hysterectomy. Photodiagnosis Photodyn Ther 2024; 45:103921. [PMID: 38097122 DOI: 10.1016/j.pdpdt.2023.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To compare the clinical efficacy and safety of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and surgery in treating vaginal high-grade squamous intraepithelial lesions (HSIL) after hysterectomy due to cervical cancer (CC) or precancerous lesions. METHODS A retrospective study was performed comprising 41 women with histologically confirmed vaginal HSIL after hysterectomy for CC or cervical HSIL. Patients were treated with surgery or ALA-PDT and were followed up at 3, 6 and 12 months and then every six months afterwards. Clinical data were collected and the efficacy and safety of the two groups were analyzed. RESULTS Of the 41 patients with vaginal HSIL after hysterectomy, 18 were treated with ALA-PDT and 23 underwent surgery. There was no significant difference in the lesions' complete remission (CR) rate or the human papillomavirus (HPV) clearance rate between the ALA-PDT group and the surgery group (P > 0.05). In the surgery group, the clearance rate of HPV16/18 was higher than that of other high-risk HPV (HR-HPV) and HPV16/18 combined with other HR-HPV (87.50 % vs. 45.45 % vs. 0.00 %, P = 0.014). No significant difference in the recurrence rate between the two groups was noted (P > 0.05). And none of the patients progressed. In the surgery group, one patient developed significant thickening of the vaginal stump, and one patient had increased vaginal discharge. In women treated with ALA-PDT, there was no vaginal bleeding or harmful effects on the organizational structure or functions compared to the surgery group. CONCLUSIONS The efficacy of ALA-PDT was comparable to that of surgery in treating vaginal HSIL following hysterectomy due to CC or cervical HSIL, with fewer side effects.
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Affiliation(s)
- Bingjie Wang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyan Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuehui Su
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuyu Yuan
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengjiao Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhuo Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhou
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lili Cao
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengzhen Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Ting Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Stuebs FA, Dietl AK, Koch MC, Adler W, Geppert CI, Hartmann A, Knöll A, Mehlhorn G, Beckmann MW, Schulmeyer CE, Heindl F, Emons J, Seibold A, Behrens AS, Gass P. Cytology and HPV Co-Testing for Detection of Vaginal Intraepithelial Neoplasia: A Retrospective Study. Cancers (Basel) 2023; 15:4633. [PMID: 37760600 PMCID: PMC10526267 DOI: 10.3390/cancers15184633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n = 86), VaIN I/vLSIL (n = 116), VaIN II/vHSIL (n = 41), VaIN III/vHSIL (n = 33), and carcinoma (n = 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II/III/vHSIL threefold. The detection rate for VaIN III/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II/III/vHSIL.
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Affiliation(s)
- Frederik A. Stuebs
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anna K. Dietl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Martin C. Koch
- Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstrasse 1, 91522 Ansbach, Germany;
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Waldstrasse 6, 91054 Erlangen, Germany
| | - Carol Immanuel Geppert
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstrasse 8–10, 91054 Erlangen, Germany
| | - Antje Knöll
- Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schlossgarten 4, 91054 Erlangen, Germany
| | - Grit Mehlhorn
- Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) Certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, 91054 Erlangen, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Carla E. Schulmeyer
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Julius Emons
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Anja Seibold
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Annika S. Behrens
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen–European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstrasse 21–23, 91054 Erlangen, Germany
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Zhang L, Wang Q, Zhang H, Xie Y, Sui L, Cong Q. Screening History in Vaginal Precancer and Cancer: A Retrospective Study of 2131 Cases in China. Cancer Manag Res 2021; 13:8855-8863. [PMID: 34858059 PMCID: PMC8631831 DOI: 10.2147/cmar.s335701] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine the screening history of vaginal intraepithelial neoplasia (VaIN) and vaginal cancer. Patients and Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Lu Zhang
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Qing Wang
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Hongwei Zhang
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yu Xie
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Long Sui
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
| | - Qing Cong
- Medical Center of Diagnosis and Treatment for Cervical Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, People's Republic of China
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Guo L, Li C, Hua K. Occult vaginal cancer recurrence after hysterectomy: a case report and literature review. J Int Med Res 2021; 48:300060520973901. [PMID: 33275476 PMCID: PMC7720318 DOI: 10.1177/0300060520973901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Vaginal cancer is a rare disease of the lower genital tract. We present the case of a 54-year-old woman with occult vaginal cancer after hysterectomy for cervical intraepithelial neoplasia (CIN) III. Despite persistently negative cytology and colposcopy results, a lesion was finally detected by vagino-recto-abdominal examination and she underwent radical parametrectomy and lymph node dissection. We consider the possibility that transabdominal suturing of the vaginal cuff after hysterectomy may reduce the ability to detect subsequent vaginal lesions, and discuss the benefits of a vaginal suture approach. We recommend that suturing the vagina apex transvaginally instead of transabdominally would benefit patients during follow-up.
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Affiliation(s)
- Luopei Guo
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunbo Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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Cao D, Wu D, Xu Y. Vaginal intraepithelial neoplasia in patients after total hysterectomy. Curr Probl Cancer 2020; 45:100687. [PMID: 33309077 DOI: 10.1016/j.currproblcancer.2020.100687] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the incidence of vaginal intraepithelial neoplasia (VaIN) after total hysterectomy and, subsequently, optimize the follow-up strategy of patients after hysterectomy. METHODS This retrospective study was conducted on 8581 patients with benign gynecology disease who underwent total hysterectomy in our institution between January 2006 to December 2017, including 834 patients with cervical intraepithelial neoplasia (CIN) and 7747 patients without cervical lesions before hysterectomy. All patients underwent postoperative high-risk human papilloma virus (Hr-HPV) screening and liquid-based cytology test (LCT) as confirmatory tests. Colposcopies were performed if the results of the confirmatory tests were abnormal, and biopsies were performed depending on colposcopy images. The mean follow-up time was 33.8 ± 12.1 months. The relationship among VaIN, CIN, and confirmatory test results was investigated. RESULTS VaIN was found in 81 patients after hysterectomy (incidence rate, 0.9%). The incidence rates of VaIN in patients with and without CIN history were significantly different (7.3%, 61/834, vs 0.3%, 20/7747; P < 0.05). Compared with patients without CIN history, those with CIN history were more likely to have abnormal LCT results in the postoperative follow-up, especially low-grade squamous intraepithelial lesions or worse (P < 0.001). Patients with high-grade squamous intraepithelial lesions in the LCT have a high VaIN incidence (patients with CIN history, 57.1%; patients without CIN history, 15.1%), and the 2 patients with squamous cell carcinoma or adenocarcinoma (SCC/AC) in the LCT had CIN and VaIN or worse after hysterectomy. The Hr-HPV infection rates after the hysterectomy of patients with and without CIN history were 18.8% (157/834) and 5.4% (419/7747), respectively. The incidences morbidities of VaIN in patients with persistent Hr-HPV infection and in those with and without CIN history were 35.7% and 12.0%, respectively, and were significantly higher than those in patients with negative Hr-HPV (patients with CIN history, 0.7%; patients without CIN history, 0.1%; P = 0.002). The incidence of VaIN in patients with CIN history with HPV-16 infection after hysterectomy was as high as 50%, but in patients without CIN history, the incidences of different Hr-HPV subtypes were not significantly different (P = 0.953). CONCLUSION Patients with CIN history were more prone to VaIN and SCC after hysterectomy than were patients without CIN history. Patients should be screened thoroughly for cervical and vaginal lesions before hysterectomy. After hysterectomy, patients with CIN history should undergo lifetime annual LCT and HPV screening.
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Affiliation(s)
- Dan Cao
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Wu
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Xu
- The Center for Cervical Disease, Shanghai Key Laboratory of Embryo Original Diseases, International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Shen F, Sun SG, Zhang XY, Wang Q, Ding JX, Hua KQ. Clinical outcomes of vaginectomy and laser ablation for the treatment of post-hysterectomy women with vaginal high-grade squamous intraepithelial lesions: A retrospective study. Eur J Obstet Gynecol Reprod Biol 2020; 248:71-76. [DOI: 10.1016/j.ejogrb.2020.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 12/21/2022]
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Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study. Arch Gynecol Obstet 2020; 301:769-777. [PMID: 31993733 DOI: 10.1007/s00404-020-05441-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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%. CONCLUSION 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.
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Gorostidi M, Lekuona A, Juaristi A, Baiocchi G. Vaginal carcinoma after cervical dysplasia. Int J Gynecol Cancer 2020; 30:265-273. [PMID: 31911538 DOI: 10.1136/ijgc-2019-001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mikel Gorostidi
- Gynecology Oncology Section, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | - Arantza Lekuona
- Obstetrics and Gynecology, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | - Arantxa Juaristi
- Pathology Department, Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
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