Clinicopathologic Study Of Vaginal Intraepithelial Neoplasia After Hysterectomy Due To High-grade Cervical Intraepithelial Neoplasia And Cervical Cancer

Ojective: To explore the clinical characteristics of and diagnostic methods for vaginal intraepithelial neoplasia(VaIN)following hysterectomy due to high-grade cervical intraepithelial neoplasia(CIN)or cervical cancer(CC).Method: Retrospectively analyzed clinical data of 139 patients who proceeded to develop Va IN after be treated with total hysterectomy for high-grade CIN or cervical carcinoma in situ,or radical hysterectomy for CC in Shengjing Hospital of China Medical University from January 1,2012 to September 1,2018.Result: Of the 139 patients,45(32.37%)of them received hysterectomy due to high-grade CIN,and 94(67.63%)of them underwent hysterectomy due to CC.There were no significant differences in menopause status,ways of removing the uterus and underlying cervical diseases among patients with different grades of Va IN(all P>0.05).The average age of these patients was 50.19±5.46 years,and the grade of VaIN for older patients was significantly higher(P<0.05).The median interval between hysterectomy and diagnosis of VaIN was 16 months,and VaIN was more likely to occur within 3 years after hysterectomy among these patients(P<0.05).Thin-prep cytology test(TCT)combined with human papillomavirus(HPV)test has a higher sensitivity for VaIN than either one of these two techniques(both P<0.05).HPV infection was detected in 82.61%of our subjects,and 95% of these infections were moderate-and high-risk.We also found that patients with the same HPV subtype infection at hysterectomy as at Va IN tend to suffer from a higher grade of VaIN(P<0.05).Conclusion: With age,patients are at an increased risk of developing high-grade Va IN.Patients who have received hysterectomy for high-grade CIN or CC should be monitored closely for the occurrence of VaIN.The combined use of HPV and TCT have a higher sensitivity for the diagnosis of VaIN.The upper third of the vagina was the area more affected,with multifocal lesions more commonly found at the vaginal vault and the two lateral fornices.HPV testing with the emphasis on specific subtypes is of great value to the diagnosis of post-hysterectomy VaIN.