| ObjectiveVaginal intraepithelial neoplasia is a relatively rare intraepithelial neoplasia of female lower genital tract.With the increase of HPV infection rate and women’s attention to physical examination,the popularization of cervical cytology,HPV detection,colposcopy,the detection rate of vaginal intraepithelial neoplasia is increasing year by year.However,there is still a lack of a unified understanding of its biological characteristics,and insufficient attention has been paid to the researches on its clinical characteristics,diagnosis,treatment and follow-up.This study retrospectively analyzed the clinical data of 247 VaIN patients admitted to the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University from January 2008 to December 2020,aiming to explore the etiology,clinical characteristics,diagnosis and treatment of VaIN,and to provide reference for the standardized diagnosis,treatment and management of VaIN in clinical work.MethodsThe clinicopathological data of 247 patients with VaIN who were admitted to the hospital for surgical treatment from January 2008 to December 2020 in the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University were collected and retrospectively analyzed,including age,chief complaint,history of present illness,past history,menstrual and reproductive history,gynecological physical signs,TCT,HPV detection,colposcopy,biopsy pathology,treatment methods,and postoperative pathology.SPSS 26.0 software was used to perform independent sample t test,Mann-Whitney rank sum test,and chi-square test for statistical analysis.Results1.The average age of the 247 VaIN patients in this study was 48.60±10.45 years,and there were more cases in the age range of 40-59 years.There were 47 patients(19.03%)with vaginal LSIL and 200 patients(80.97%)with vaginal HSIL,with an average age of 47.77±11.42 years and 48.79±10.24 years respectively.There was no significant difference in age between the two groups(P=0.547).148(59.92%)patients had no obvious clinical symptoms and came to hospital because of abnormal TCT and HPV detection in the health checkup.72(29.15%)patients found VaIN in the follow-up after treatment of cervical lesions,and 1(0.40%)was found to have recurrence during the follow-up after VaIN surgery.26(10.53%)patients had clinical symptoms,among whom 12(4.86%)had contact bleeding,11(4.45%)had irregular vaginal bleeding,2(0.81%)increased vaginal discharge,and 1(0.40%)had vulvovaginal itching.The medical records of 228 cases clearly recorded the location of the lesions.The lesions of 218 cases(95.61%)were located in the upper 1/3 of the vaginal wall,9 cases(3.95%)were in the upper and middle 2/3 of the vaginal wall,and 1 case(0.44%)had multifocal involvement in the upper,middle and lower vaginal walls.107 cases(43.32%)were menopausal.The average menopause time in the vaginal HSIL group was 8.63±6.16 years,significantly longer than 5.60±4.36 years in the vaginal LSIL group.The difference was statistically significant(P=0.03 9).2.A total of 236 patients underwent HPV detection,and the HPV positive rate was 96.61%.The positive rates of high-risk HPV in vaginal HSIL and LSIL patients were 96.35%(185/192)and 97.73%(43/44)respectively,and there was no significant difference between the two groups(P=0.638).The HPV types with higher positive rate were HPV16(48.73%),HPV18(9.32%),HPV58(8.90%),HPV56(5.51%),HPV31(5.08%),HPV52(5.08%).HPV16 had the highest positive rate in vaginal HSIL(38.64%),followed by HPV18(8.51%),HPV31(8.51%)and HPV56(8.51%).Among vaginal HSIL cases,HPV 16 had the highest positive rate(59.59%),followed by HPV18(11.40%),HPV58(10.88%),HPV56(6.74%),and HPV33(4.66%).36 cases of vaginal HSIL underwent quantitative detection of high-risk HPV,with the viral loads ranging 0.25-2871.85.And 6 cases of vaginal LSIL underwent quantitative detection of high-risk HPV,with the viral loads ranging 189.21-2426.28.There was no significant difference between the viral loads of vaginal HSIL and LSIL cases(P=0.971).A total of 206 patients underwent TCT.The abnormal rates of TCT in vaginal LSIL and HSIL patients were 69.05%and 81.10%respectively,with no statistically significant difference between them(P=0.050).The TCT results of vaginal LSIL patients were mainly LSIL(3.71%)and NILM(30.95%),and the TCT results of vaginal HSIL patients were mainly LSIL(32.93%)and ASC-US(28.05%).The overall sensitivity of TCT and HPV combined screening was 98.99%,which was not significantly different from the sensitivity of HPV detection(96.61%,P=0.10).However,it was significantly higher than the 78.64%sensitivity of TCT detection(P=0.00).3.A total of 218 patients underwent colposcopy biopsy and surgical resection.The preoperative biopsy was consistent with the postoperative pathological diagnosis in 86 cases(39.45%).125 cases(57.34%)were overdiagnosed and 7 cases(3.21%)were underdiagnosed.4.In this study,the rate of cervical lesions in vaginal HSIL patients was 78.00%,which was significantly higher than that in vaginal LSIL patients(61.70%).The difference was statistically significant(P=0.02).There were 7 patients(2.83%)with VIN,including 1(0.40%)with vulvar LSIL,6(2.43%)with vulvar HSIL,and 4(1.62%)with both CIN and VIN.5.A total of 47 patients(19.03%)had a history of hysterectomy,of which 31 patients(12.55%)underwent hysterectomy due to cervical lesions,and 16 patients(6.48%)underwent hysterectomy due to uterine fibroids,adenomyosis and other reasons.The average interval of VaIN in patients after hysterectomy due to cervical lesions was 33.38±37.78 months,which was significantly shorter than the average interval of VaIN in patients who underwent hysterectomy for other reasons,107.60±90.95 months.The difference was statistically significant(P=0.008).6.Among 200 patients with vaginal HSIL,5(2.5%)cases underwent electrocautery,2 cases(1%)underwent transabdominal extensive trachelectomy and partial vaginectomy,and 63 cases(31.5%)underwent transabdominal or laparoscopic hysterectomy and partial vaginectomy.47 cases(23.5%)underwent cervical conization and partial vaginectomy,and 83 cases(41.5%)underwent partial vaginectomy.Among the 90 patients whose follow-up data were available,31 patients(34.44%)had TCT abnormality and negative HPV detection after treatments,and 4 patients(4.44%)underwent partial vaginectomy again for the recurrence of VaIN.3 cases(3.33%)progressed to vaginal squamous cell carcinoma,of which one case(1.1%)was diagnosed with vaginal invasive squamous cell carcinoma after two recurrences of vaginal HSIL.Conclusions1.Most of VaIN cases have no specific clinical manifestations,and the lesions are mostly located in the upper 1/3 of the vagina.And VaIN is often accompanied by CIN and cervical cancer.2.HPV detection has high sensitivity in the screening of VaIN,and it can achieve better detection results if combined with TCT.3.For VaIN patients,colposcopy and biopsy of suspicious lesions are helpful to confirm the diagnosis.For patients with cervical lesions,it is recommended to carefully check the vaginal mucosa with colposcopy before surgery,and follow up closely after surgery to avoid missed diagnosis of VaIN.4.The treatment of VaIN should be individualized.Surgery is one of the main options for patients with recurrent,high-grade VaIN and suspected invasive cancer. |
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