Early Diagnostics of Vulvar Intraepithelial Neoplasia

Abstract

The spectrum of vulvar lesions ranges from infective and benign dermatologic conditions to vulvar precancer and invasive cancer. Distinction based on the characteristics of vulvar lesions is often not indicative of histology. Vulvoscopy is a useful tool in the examination of vulvar pathology. It is more complex than just colposcopic examination and presumes naked eye examination accompanied by magnification, when needed. Magnification can be achieved using a magnifying glass or a colposcope and may aid the evaluation when a premalignant or malignant lesion is suspected. It is a useful tool to establish the best location for biopsies, to plan excision, and to evaluate the entire lower genital system. Combining features of vulvar lesions can help prediction of its histological nature. Clinically, there are two distinct premalignant types of vulvar intraepithelial neoplasia: HPV-related VIN, more common in young women, multifocal and multicentric; VIN associated with vulvar dermatoses, more common in older women and usually unicentric. For definite diagnosis, a biopsy is required. In practice, the decision to perform a biopsy is often delayed due to a lack of symptoms at the early stages of the neoplastic disease. Clinical evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer may be present.

Human papillomavirus genotyping in high‐grade vaginal intraepithelial neoplasia: A multicentric Italian study

“…We also reported the high burden of other associated HPV‐related intraepithelial neoplasm of the lower genital tract that are more frequent in higher grade VaIN, with 44.6% of VAIN2/3 having an associated previous or concurrent cervical HSIL and 3.2% an associated vulvar HSIL. These data support the importance of a thorough examination of the cervix, and the vulva 19–21 during vaginal colposcopic examination of patients affected by VaIN and highlights once again the strong HPV field effect, in particular for HPV 16 22,23 …”

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia

“…VaIN may recur after several years, and therefore long-term follow-up is recommended. Because lower genital tract intraepithelial neoplasia is often multi-zonal, vulvoscopy and anoscopy in the presence of high-grade vulvar lesions should be considered during follow-up of patients treated for VaIN 2/3 118 …”

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) consensus statement on the management of vaginal intraepithelial neoplasia

“…Because lower genital tract intraepithelial neoplasia is often multi-zonal, vulvoscopy and anoscopy in the presence of high-grade vulvar lesions should be considered during follow-up of patients treated for VaIN 2/3. 118 Prevention Prevention of VaIN follows the principles for prevention of squamous intraepithelial neoplasia at other anogenital sites and presumes avoiding risk factors such as smoking, long-term oral contraception, multiple sexual partners, and unsafe sex. Persistent HPV infection, particularly by HPV 16, has been associated with the long-term development of HSIL (VaIN 2/3) and carcinoma of the vagina.…”