Differentiated-Type Vulval Intraepithelial Neoplasia Has a High-Risk Association With Vulval Squamous Cell Carcinoma

Pan Birmingham Cancer Centre, Birmingham, UK.
International Journal of Gynecological Cancer (Impact Factor: 1.95). 06/2009; 19(4):741-4. DOI: 10.1111/IGC.0b013e3181a12fa2
Source: PubMed


To assess the potential malignant risk of vulval premalignant conditions, in particular, to investigate whether there is a difference in the cancer risk between women with the 2 types of vulval intraepithelial neoplasia (VIN).
All vulval biopsy specimens taken for any reason in a single center for a 5-year period were identified. The histologic reports of 1309 biopsy specimens from 802 women were reviewed, and all pathologic conditions present were recorded for each woman. Reports of patients with biopsy specimens containing usual-type VIN, differentiated-type VIN, lichen sclerosus, and squamous hyperplasia were selected and analyzed for the presence of metachronous or subsequent carcinoma to give a proportional risk for each condition.
Five hundred eighty women were identified with premalignant vulval conditions: 171 had usual-type VIN, 70 had differentiated-type VIN, 191 had lichen sclerosus, 145 had squamous hyperplasia, and 3 had other conditions not included in this analysis. Within these groups, the numbers of women with prior, synchronous, or subsequent vulval squamous cell carcinoma were 44 (25.7%), 60 (85.7%), 53 (27.7%), and 53 (31.7%), respectively (P = 0.000).
Differentiated-type VIN is significantly more associated with vulval squamous cell carcinoma than usual-type VIN.

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    • "Each pathway has its own precursor lesion (Maclean, 2006; van der Avoort et al, 2006); usual VIN (uVIN) is the first precursor and is caused by the human papilloma virus (HPV). Differentiated vulvar intraepithelial neoplasia (dVIN) is the second and most common precursor and often occurs in a background of lichen sclerosus (LS) (Yang and Hart, 2000; Eva et al, 2009). On the basis of our earlier studies we conclude that dVIN and not LS is the true precursor of SCC (van de Nieuwenhof et al, 2010). "
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    ABSTRACT: Taking a biopsy is a standard procedure to make the correct diagnosis in patients with suspicious premalignant vulvar lesions. The use of a less invasive diagnostic tool as triage instrument to determine whether biopsy is necessary may improve patient comfort especially in patients with chronic vulvar disorders that may warrant consecutive biopsies. This study was conducted to investigate whether vulvar brush cytology is feasible and may be used to detect (pre)malignant vulvar lesions. A pilot study was performed with patients having clinically normal vulvar skin, lichen sclerosus (LS), usual or differentiated vulvar intraepithelial neoplasia or squamous cell carcinoma. A total of 65 smears were taken with the use of a vulvar brush and biopsies were performed for histopathological analysis. Out of 65 smears, 17 (26%) were discarded because of poor cellularity. A total of 28 of 29 (97%) smears with a histological proven (pre)malignancy had a smear classified as 'suspicious' or 'uncertain'. Cytology classified 11 smears as 'non-suspicious', of which 10 (91%) were indeed normal skin or LS. The accuracy, based on the presence of a lesion, for (pre)malignant lesions with the use of the brush showed a sensitivity of 97% and a negative predictive value of 88%. Vulvar brush cytology is feasible and may be a first step in the development of a triage instrument to determine whether subsequent biopsy of a clinically (pre)malignant lesion is necessary.
    British Journal of Cancer 12/2011; 106(2):269-73. DOI:10.1038/bjc.2011.533 · 4.84 Impact Factor

  • International Journal of Gynecological Cancer 01/2010; 20(1):194. DOI:10.1111/IGC.0b013e3181bc1bf4 · 1.95 Impact Factor
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