Abnormal Pap Smear and Diagnosis of High-Grade Vaginal Intraepithelial Neoplasia: A Retrospective Cohort Study.
The aim of this study was to analyze the correlation between the first diagnosis of high-grade Vaginal Intraepithelial Neoplasia (HG-VaIN: VaIN 2-VaIN 3) and the cytological abnormalities on the referral pap smear.All the women with histological diagnosis of HG-VaIN consecutively referred to the Gynecological Oncology Unit of the Aviano National Cancer Institute (Aviano, Italy) from January 1991 to April 2014 and with a pap smear performed in the 3 months before the diagnosis were considered, and an observational cohort study was performed.A total of 87 women with diagnosis of HG-VaIN were identified. Major cytological abnormalities (HSIL and ASC-H) on the referral pap smear were significantly more frequent than lesser abnormalities (ASC-US and LSIL) in postmenopausal women (64.9% vs 36.7%, P = 0.02) and in women with a previous diagnosis of HPV-related cervical preinvasive or invasive lesions (70.5% vs 39.5%, P = 0.01). Diagnosis of VaIN 3 was preceded by major cytological abnormalities in most of the cases (72.7% vs 27.3%, P < 0.001).The diagnosis of HG-VaIN can be preceded by different abnormalities on referral pap smear. Major abnormalities are usually reported in postmenopausal women and in women with previous cervical HPV-related disease. However, ASC-US or LSIL do not exclude HG-VaIN, especially VaIN2. An accurate examination of the whole vaginal walls (or vaginal vault) must be performed in all the women who underwent colposcopy for an abnormal pap smear, and a biopsy of all suspicious areas is mandatory.
From the Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute (FS, GDP, MB, GG); and Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy (FM, NC, AC).
Francesco
F
Sopracordevole
Francesca
F
Mancioli
Nicolò
N
Clemente
Giovanni
G
De Piero
Monica
M
Buttignol
Giorgio
G
Giorda
Andrea
A
Ciavattini
D000293:Adolescent; D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D065006:Papanicolaou Test; D012189:Retrospective Studies; D014625:Vaginal Neoplasms / Q000473:pathology*; D014626:Vaginal Smears; D055815:Young Adult