<p>Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia</p>

Abstract

To evaluate the colposcopic accuracy of the detection of vaginal intraepithelial neoplasia (VaIN) according to the colposcopic terminology for the vagina from the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC). Methods: A total of 467 women who were suspected of having VaIN and underwent colposcopy at Obstetrics and Gynecology Hospital of Fudan University from January to December 2018 were included in this retrospective cohort study. The 2011 IFCPC revised terminology for the vagina was applied, and the agreement between colposcopic diagnosis and vaginal biopsy pathology was analysed. Results: Agreement between colposcopy and pathology was 69.16% (kappa=0.437, p<0.001), with 23.34% overestimated and 7.49% underestimated diagnosis for colposcopy. The agreement was the lowest (35.71%) in the high-grade VaIN group, which was significantly different from that of other lesion grade groups (p<0.01). Among grade 1 findings, thin acetowhite epithelium was the most frequent (80.51%). Grade 2 findings and vascular patterns were rare. The positive predictive values of the micropapillary pattern were 55.98% for low-grade VaIN and 5.98% for high-grade VaIN. The specificity of iodine negativity was 10.92% for low-grade VaIN and 8.30% for high-grade VaIN. There were significant differences in the maximum size of single lesions and in the number of lesions among different grade lesion groups. Conclusion: The agreement between colposcopy findings utilizing the 2011 IFCPC terminology and vaginal pathology is moderate, and more definite findings for high-grade VaIN may be needed. The micropapillary pattern can be considered an alternative low-grade finding, while iodine staining is nonspecific for all lesions. Scattered and spotty lesions suggest low-grade VaIN, while large single lesions suggest high-grade VaIN.

Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients

“…VAIN is a rare disease of the lower genital tract, and it affects approximately 0.2 × 100.000 persons per year, 3 accounting for 0.6%-1% of CIN cases. 4 In the present study, VAIN accounted for 1.7% of CIN cases; this estimate is higher than that reported in international studies. In the present study, the average age at diagnosis was 49.81 ± 9.77 (range: 26-70) years, which is consistent with that previously reported.…”

“…VAIN is a rare disease of the lower genital tract, and it affects approximately 0.2 × 100.000 persons per year, 3 accounting for 0.6%–1% of CIN cases 4 . In the present study, VAIN accounted for 1.7% of CIN cases; this estimate is higher than that reported in international studies.…”

“…Early international studies estimated the incidence of vaginal intraepithelial neoplasia (VAIN) at 0.2-2/10 million, accounting for 0.4% of all lower reproductive tract epithelial neoplasia cases. 1 However, with improvements in screening methods such as cytology, HPV testing, and colposcopy, [2][3][4] the number of cases detected annually has increased, although the reported values are likely to be underestimates. Nevertheless, the disease remains rare; therefore, its epidemiologic pattern, natural history, and associated treatment outcomes remain poorly understood.…”

Fluorescence colposcope with dye TMTP1-PEG4-ICG is comparable to the conventional colposcope with acetic acid and Lugol's iodine in identifying cervical precancerous lesions - A randomized controlled trial

“…Therefore, this fluorescence colposcope was not suitable for detecting vaginal intraepithelial neoplasia (VIN). Conventional colposcopy-guided biopsy with acetic acid and Lugol's iodine was crucial in detecting VIN 23,24 . In order to avoid missed diagnosis of VIN or vaginal cancer in this study, suspicious vaginal lesions were also sampled for biopsy.…”

Screening History in Vaginal Precancer and Cancer: A Retrospective Study of 2131 Cases in China

“…Colposcopic examinations and diagnoses were performed by experienced colposcopists following the 2011 International Federation of Cervical Pathology and Colposcopy terminology. 17 A detailed description of colposcopic findings and initial diagnosis were recorded based on our previous study: 18 1) General assessment: adequate or inadequate; 2) Normal colposcopic findings: mature or atrophic squamous epithelium; 3) Abnormal colposcopic findings: the location (anterior, posterior, or lateral) and total size of the lesion; the maximum size of single lesion and the number of lesions; Grade 1 (minor) including thin acetowhite epithelium, fine punctuation and fine mosaic; Grade 2 (major) including dense acetowhite epithelium, coarse punctuation and coarse mosaic; suspicious for invasion including atypical vessels, fragile vessels, and an irregular surface; and nonspecific findings including columnar epithelium (adenosis); 4) Miscellaneous findings: erosion, condyloma, polyp, cyst, endometriosis, etc; 5) Finally, colposcopic impression was reckoned, which was classified as normal or benign lesion, VaIN 1, VaIN 2/3, or suspicion of cancer. Based on the application of 5% acetic solution and Lugol’s iodine solution, targeted biopsies of suspected cervical, vaginal, and vulvar lesions were performed.…”