Prediction of persistent vaginal intraepithelial neoplasia in previously hysterectomized women by high-risk HPV DNA detection.
OBJECTIVE
To estimate the incidence and latency of Vaginal Intraepithelial Neoplasia (VAIN) in women previously hysterectomized for benign/malign pathology and to evaluate the role of high risk HPVs in the prediction of persistent or recurrent disease.


METHODS
830 women with prior hysterectomy for benign/malign pathologies followed by cytological scraping and vaginal colposcopy. Forty-four patients presented VAIN lesions confirmed by histopathological diagnosis. HPV DNA test was performed at the time of diagnosis. Patients were treated by Laser CO(2) vaporization and underwent follow-up by cytology, colposcopy for a mean period of 3 years. HPV DNA test was performed at 6 months after treatment and every years. Persistent or relapsed disease was confirmed by histopathology.


RESULTS
Incidence of VAIN in women hysterectomized for benign pathologies did not differ significantly from the malign group. VAIN degree was more severe in the hysterectomized patients with cervical malignancy and subsequently radiated respect to non-radiated patients. The HPV DNA test at 6 months after VAIN treatment showed fifteen positive cases: twelve HPV 16 (80%) and three HPV 18 (20%). In five cases HPV DNA test was positive with a persistent negative cytological smear during the years. Positivity to high-risk HPV (either 16 or 18) was significantly higher in the patients with relapse to VAIN (10/44, p<0.002).


CONCLUSIONS
We suggest to include HPV DNA test in addition to cytology in the follow-up of patients previously treated for VAIN, in order to predict VAIN persistence or progression in vaginal carcinoma before cytology becomes abnormal.
Frega
A
A
Department of Gynecology, Perinatology and Child Health, Faculty of Medicine, University "La Sapienza", Rome, Italy. a.frega@tin.it
French
D
D
Piazze
J
J
Cerekja
A
A
Vetrano
G
G
Moscarini
M
M
D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000453:epidemiology / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D052162:Human papillomavirus 16 / Q000235:genetics; D052161:Human papillomavirus 18 / Q000235:genetics; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D011237:Predictive Value of Tests; D014625:Vaginal Neoplasms / Q000453:epidemiology / Q000821:virology*
D004279:DNA, Viral