Journal of Lower Genital Tract Disease

Publisher: American Society for Colposcopy and Cervical Pathology, Lippincott, Williams & Wilkins

Journal description

The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology (ASCCP). ASCCP was established in 1964 and is dedicated to promoting education and research in the fields of colposcopy and cervical pathology. The Journal is peer-reviewed, and it publishes (1) original articles in basic science and clinical practice, (2) editorial comment, (3) invited and volunteer commentary, (4) review articles, (5) case reports, (6) correspondence, (7) book reviews, (8) instructional cases with photographs for the Home Study Course, (9) abstracts from relevant meetings, and (10) description of technique/technology. The Journal of Lower Genital Tract Disease is the source for the latest science in the field of diagnosis, etiology, and therapy of pathologic conditions of the cervix, vagina, and vulva. Its readers are members of the ASCCP and the International Federation of Cervical Pathology and Colposcopy (IFCPC) and interested individuals from many different disciplines including pathology, cytology, cytogenetics, gynecologic oncology, endocrinology, preventive medicine, basic science, and clinical medicine.

Current impact factor: 1.99

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 1.994
2013 Impact Factor 1.11
2012 Impact Factor 1.207
2011 Impact Factor 1.069
2010 Impact Factor 1.273

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.62
Cited half-life 3.80
Immediacy index 0.45
Eigenfactor 0.00
Article influence 0.51
Website Journal of Lower Genital Tract Disease website
Other titles Journal of lower genital tract disease (Online), Journal of lower genital tract disease
ISSN 1089-2591
OCLC 41986145
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Lippincott, Williams & Wilkins

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author cannot archive a post-print version
  • Restrictions
    • 12 months embargo
  • Conditions
    • Some journals have separate policies, please check with each journal directly
    • Pre-print must be removed upon acceptance for publication
    • Post-print may be deposited in personal website or institutional repository
    • Publisher's version/PDF cannot be used
    • Must include statement that it is not the final published version
    • Published source must be acknowledged with full citation
    • Set statement to accompany deposit
    • Must link to publisher version
    • NIH authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 12 months embargo (see policy for details)
    • Wellcome Trust and HHMI authors will have their accepted manuscripts transmitted to PubMed Central on their behalf after a 6 months embargo (see policy for details)
    • Publisher last reviewed on 19/03/2015
  • Classification
    yellow

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: High-risk human papillomavirus (hrHPV) is now recognized as a single, necessary cause of cancer of the cervix. Although Pap tests have been central to cervical cancer screening programs for more than 50 years, tests that detect infection with these hrHPV genotypes are now being used increasingly in cervical cancer screening programs. Objective: The aim of the study was to determine the sensitivity of an HPV test to detect cervical cancer. Materials and methods: Fifty successive cervical samples from women diagnosed with invasive cervical cancer were tested using a molecular HPV DNA test. Thereafter, the residual sample was further tested with a different HPV genotyping test (capable of detecting 27 low- and high-risk types of HPV) and a nucleic acid hybridization test (capable of detecting 13 high-risk types of HPV). Results: Of the 50 women tested, the first HPV test was positive in 47 cases. Of the 3 negative cases, all were negative by second polymerase chain reaction-based test and 2 were negative by the nucleic acid hybridization test. Human immunodeficiency virus status was positive in 14 women, the majority of whom were positive for HPV 16 (n = 8) and 1 was HPV negative. Most women were diagnosed with having stage II cervical cancer or higher. Conclusions: With a sensitivity of 94% of the first HPV test, 6 of 100 cervical cancers will be missed if this was the only test used in a population screening program. The missed cancers were however all clinically detectable.
    No preview · Article · Feb 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of the study was to determine whether p16 positive/cervical intraepithelial neoplasia (CIN) 2, 3, and cancer (p16 + CIN 2/3+) detected by colposcopy-directed or random biopsy differ by age, referral cytology, human papillomavirus (HPV) 16, and lesion size. Materials and methods: Data from the Shenzhen Cervical Cancer Screening Trial II where, at colposcopy, women who had directed and random cervical biopsies were reviewed to find women with CIN 2, 3, or cancer; 227 such women identified had their paraffin-embedded tissue blocks recut, reviewed, and then immune stained for p16. Data were analyzed by χ, Fisher exact test, and linear regression. Results: After histopathologic review and p16 staining of CIN 2, 175 women were diagnosed with p16 + CIN 2/3+. When compared with those diagnosed by colposcopy-directed biopsy (n = 138), those diagnosed by random biopsy (n = 37) were more likely to have Cytology-Lo (cytology of negative, atypical squamous cells of undetermined significance, or low-grade squamous intraepithelial lesion; p = .07), less likely to have HPV 16 (p = .041), more likely to be 51 years or older (p = .022), and more likely to have 1 quadrant lesions (p < .001). Logistic regression analysis showed p16 + CIN 2/3+ diagnosed by random biopsy was predicted by 1 quadrant lesions (p < .0001) and age of 51 years or older (p = .03) but not by Cytology-Lo (p = .71) nor HPV 16 (p = .26). Conclusions: Women with p16 + CIN 2/3+ diagnosed by random biopsy are older and less likely to have HPV 16; hence, CIN diagnosed by random biopsy may not be as virulent as CIN diagnosed by colposcopy-directed biopsy. Regardless, we advise that CIN diagnosed by random biopsy be viewed like CIN diagnosed by colposcopy-directed biopsy.
    No preview · Article · Feb 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Vulvar squamous cell carcinoma (VSCC) develops through 2 distinct molecular pathways, one involving high-risk human papillomavirus (HPV) infection and the other through early p53 suppressor gene mutation. We sought to evaluate the influence of p53 mutation, HPV status, and p16 expression on local recurrence and disease-specific mortality in early stage VSCC. Materials and methods: We performed a retrospective chart review of all patients with stage I VSCC at the Maine Medical Center from 1998 to 2007 (n = 92). Tumor size, depth of invasion, lymphatic/vascular space invasion, and growth pattern were recorded. Paraffin-embedded tissue blocks were stained by immunohistochemistry for p16 and p53; high-risk HPV was detected by polymerase chain reaction assay. Margin distance was determined by a gynecologic pathologist. Survival analyses were conducted to examine predictors of VSCC recurrence and disease-specific mortality. Results: Age, depth of invasion, lymphatic/vascular space invasion, growth pattern, and margin status were not significant predictors of recurrence or disease-specific mortality. Tumor size of greater than 4.0 cm indicated a 4-fold increase in disease-specific mortality but did not significantly increase recurrence. p16-Positive patients were less likely to recur and had no VSCC-related deaths. Human papillomavirus-positive patients were less likely to recur and had no VSCC-related deaths. p53-positive patients were 3 times more likely to recur and nearly 7 times more likely to die from vulvar cancer. Conclusions: Our findings suggest that HPV and the surrogate biomarker p16 indicate a less aggressive type of vulvar cancer. p53 positivity was associated with poor prognosis and significantly increased both recurrence and disease-specific mortality.
    No preview · Article · Feb 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of this study was to determine if there is a different p16 expression pattern between colposcope-directed and random (colposcope-undetectable) biopsies of cervical intraepithelial neoplasia (CIN2) and CIN3. Methods: Cervical biopsies that were positive for CIN2 or CIN3 were selected from a database of samples acquired during a large population-based clinical trial in Guangdong Province in China (Shenzhen Cervical Cancer Screening Study II). Blocks were recut, reread, and then immunostained for p16. Biopsies were categorized as either colposcope-directed or random biopsies. Diffuse staining was considered p16 positive, whereas focal or no staining was considered p16 negative. Differences were determined by the Fisher exact test. Results: Among the patients with CIN3, there were 232 individual biopsies of CIN3. Sixty were randomly collected, and 172 were colposcopy directed. p16 positivity for the colposcope-directed and random biopsies was 97.7% and 91.7%, respectively (p = 0.052). Like the CIN3 biopsies, colposcope-directed and random CIN2 samples expressed p16 similarly (86.8% [46/53] and 82.6% [19/23], p = .73, respectively). Conclusions: Based on our data, even small colposcope-undetectable biopsies of CIN3 are significant. Random biopsies of CIN2 or CIN3 demonstrate similar p16 positivity as visible lesions and therefore might be expected to have a similar natural history.
    No preview · Article · Feb 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Loop electrosurgical excision procedures (LEEPs) are negative for high-grade cervical intraepithelial neoplasia (CIN 2+) after a hematoxylin and eosin-based CIN 2+ colposcopic biopsy diagnosis in 14% to 24% of cases. This may be due to diagnostic errors or biopsy-related regression of the dysplasia. Because p16 immunohistochemical staining of cervical biopsies improves diagnostic accuracy, we hypothesized that p16-based cervical biopsy diagnoses may reduce the frequency of negative LEEPs. Materials and methods: We performed a retrospective cross-sectional study of all cervical LEEPs completed at our institution from 2002 to 2012. We recorded patient age, sexual history, smoking history, pathologic diagnoses (including whether the diagnosis was p16 based), the number of days from biopsy to follow-up LEEP, and clinical follow-up. This yielded 593 study subjects meeting inclusion criteria of CIN 2+ colposcopic diagnoses with follow-up LEEP and 2 years of clinical follow-up. Colposcopic biopsies and follow-up LEEPs were reviewed and p16 immunostaining was performed on all samples to provide criterion standard results. Data were analyzed by χ and regression modeling. Results: Our practice employed p16 to aid cervical biopsy diagnoses by 2006. The frequency of negative LEEPs before 2006 was 12 (10%) of 126. The frequency dropped during the p16 era (2006-2012) to 23 (5%) of 467. Overall, we observed an inverse relationship between the frequency of p16 employment and the frequency of negative LEEP outcomes (R = 0.71; p < .001), independent of potential covariates. Conclusions: Our data suggest that more accurate p16-based diagnoses may reduce the frequency of unnecessary LEEPs.
    No preview · Article · Feb 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Although microglandular hyperplasia is a benign endocervical lesion, it may raise concern of malignancy in an inexperienced pathologist, because clinicians may not be familiar with it on a report. It has been reported to occur in association with progestational stimulation, but this has not been well studied. The aim of the study was to evaluate this potential association. Materials and methods: This was an observational case control study of patients seen from January 01, 1991 to November 01, 2014 at the University Hospital, Newark, New Jersey. Cases of microglandular hyperplasia and controls were identified from the files of the Department of Pathology. Controls were cases of endocervical curettages for whom no microglandular hyperplasia was detected. Medical records were reviewed for evidence of exogenous progestin exposure within the previous 6 months. Results: Eighty-nine cases of microglandular hyperplasia and 97 controls were identified. Of the cases of microglandular hyperplasia, 26 (29.2%) of 89 cases had exposure to progestational medication, significantly greater than that of controls (10/97, 10.3%; p = .0014). Conclusions: Our data show that a significantly higher percentage of women with microglandular hyperplasia had progestin exposure than women who do not exhibit this benign lesion. Clinicians and pathologists should be aware of this association, as well as the benign nature of the lesion.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease

  • No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Large loop excision of the transformation zone (LLETZ) is the standard surgical treatment for cervical dysplasia. The optimal way to achieve local hemostasis in women undergoing LLETZ is unknown. Materials and methods: In a prospective, randomized trial, we compared spray coagulation and forced coagulation in women undergoing LLETZ in a 1:1 ratio. The primary endpoint was time to complete local hemostasis (TCLH). Secondary endpoints were blood loss (Δ hemoglobin before and after LLETZ), pain (numerical visual analog scale, 5-step graphical visual analog scale measured 2-3 hours after LLETZ), and perioperative/postoperative complications (intraoperative need for sutures, postoperative bleeding, infection, and unscheduled readmission). Analysis was by intention to treat. Results: One hundred fifty-one women were enrolled and were eligible for analysis. Mean (SD) TCLH in 80 women with forced coagulation was 43.3 (38.5) and 28.9 (22.9) seconds in 71 women with spray coagulation (p < 0.001). The secondary endpoints blood loss (Δ hemoglobin, -0.8 [0.8] vs -0.7 [1.1]; p = 0.115), pain (numerical visual analog scale, 4.1 [0.9] vs 4.2 [0.9]; p = 0.283, graphical visual analog scale (1.9 [1.3] vs 1.8 [1.3]; p = 0.888), and perioperative/postoperative complications (6/71 [8%] vs 7/80 [9%]; p = 0.822) were comparable between the 2 arms. In a multivariate analysis, coagulation method (odds ratio = 0.18; 95% CI = 0.09-0.38; p < 0.001) and size of the cervix (odds ratio = 2.43; 95% CI = 1.16-5.15; p = 0.021) were independent predictors of TCLH. Conclusions: Spray coagulation is superior to forced coagulation in women undergoing LLETZ and should be used as the standard approach.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Erosive lichen planus (LP) and differentiated vulvar intraepithelial neoplasia (dVIN) may display overlapping histopathologic features. Materials and methods: We searched the local pathology database for vulvar biopsies reported as dVIN or erosive vulvitis during 2011 to 2013 inclusive. After review of patient notes and slides, there were 5 cases with a clinical appearance and course consistent with erosive LP and histopathology showing epithelial regeneration. We then selected 5 cases of dVIN in which the clinical course and histopathology supported the diagnosis. We performed immunohistochemistry for p16 and p53 on all cases and did copy variant analysis on 1 case each of erosive LP and dVIN. Results: Histopathology of the LP cases showed epithelial thinning, absent stratum corneum, lack of maturation, as well as nuclear changes of enlargement, pleomorphism, and hyperchromasia. Three LP cases (60%) showed a wild-type p53 pattern and 2 (40%) were confluent positive. Two dVIN cases (40%) showed full-thickness loss of differentiation. One case (20%) of dVIN was p53 negative, 2 (40%) were wild-type, 1 was confluent positive, and 1 showed dark suprabasilar staining. All cases were negative for p16. Compared with control, erosive LP epithelium showed a similar copy-number pattern, whereas the dVIN epithelium had many copy-number changes. Conclusions: A small subset of clinically diagnosed vulvovaginal erosive LP will show on histopathology a regenerative erosive vulvitis with loss of epithelial maturation and nuclear changes, which requires clinicopathologic correlation to distinguish from dVIN.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: This case illustrates that a very benign looking lesion can be an aggressive cancer. Vulvar lesions need a biopsy to rule out malignancy if they are painful, progressing in size, or changing in appearance.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: The aims of the study were to examine barriers to cervical cancer screening among women who have experienced intimate partner violence (IPV) and accessed domestic violence shelters, to compare barriers among those up-to-date (UTD) and not UTD on screening, and to evaluate acceptability of human papillomavirus self-sampling. Materials and Methods: This is a cross-sectional survey in which domestic violence shelters in Ohio were identified and women completed an anonymous survey assessing UTD screening status, barriers related to screening, history of IPV, intention to follow up on abnormal screening, and acceptability of self-sampling. Characteristics of UTD and not UTD women were compared using Mann-Whitney U tests. Results: A total of 142 women from 11 shelters completed the survey. Twenty-three percent of women were not UTD. Women who were not UTD reported more access-related barriers (mean = 2.2 vs 1.8; p = .006). There was no difference in reported IPV-related barriers between women who were not UTD and those who are UTD (mean = 2.51 in not UTD vs 2.24 in UTD; p = .13). Regarding future screening, of the women who expressed a preference, more women not UTD preferred self-sampling than UTD women (32% vs 14%; p = .05). Conclusions: In this study, access-related barriers were more commonly reported among women not UTD with screening. Addressing these barriers at domestic violence shelters may improve screening among not UTD women. Self-sampling may also be one feasible approach to support screening in this population.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The aim of the study was to assess the histology of normal vulvar skin with attention to anatomic location and epithelium type. Materials and Methods We performed a retrospective histologic review of 118 vulvar biopsies and excisions obtained between 2010 and 2014 with adjacent normal skin or mucosa. Exclusions included age younger than 18 years, vestibulectomy, labiaplasty, inflammatory dermatoses, and insufficient normal tissue for assessment. Stratum corneum morphology was assessed as basket weave, compact, or intermediate. Stratum granulosum cell layer number and epithelial thickness were recorded. Dermal lymphocytic infiltrate was described as nil, sparse, moderate, or dense. Fischer exact test, Pearson χ2, and Student t test were used for statistical analysis. Results There were 7 cases from mons pubis, 11 from perineum, 83 from labia, and 17 from vestibule. In the skin, the stratum corneum morphology was basket weave in 31%, compact in 35%, and intermediate in 34%. Stratum corneum at the mons pubis was uniformly basket weave, whereas at perineum, it was either compact or intermediate (7/7 vs 0/11; p <.001); the labia demonstrated all 3 morphologies. Parakeratosis (PK) was identified at the specimen edge in 4 cases of hairless skin and 7 cases of squamous mucosa. Mean epithelial thickness and dermal lymphocytic infiltration were similar in specimens with and without PK. Conclusions Compact stratum corneum of vulvar skin and a zone of PK at the mucocutaneous junction may be normal histological findings. Pathologists need to be aware of site-related differences of the vulvar epithelium to avoid overdiagnosis of pathological conditions.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Successful cervical cancer screening in the United States–Affiliated Pacific Islands (USAPI) is limited by geographic, political, economic, and logistic factors. An expert panel convened to examine screening in each of the 6 island jurisdictions and to explore options beyond cytology-based screening. Materials and Methods: Forty-one representatives of American Congress of Obstetrics and Gynecology, American Society for Colposcopy and Cervical Pathology, government agencies, the World Health Organization, Pan American Health Organization, health representatives of the 6 Pacific island jurisdictions, Puerto Rico, and several academic institutions met in a 2-day meeting to explore options to improve access and coverage of cervical cancer screening in the USAPI. Results: Cytology-based screening is less widely accessed and less successful in the USAPI than in the United States in general. Barriers include geographic isolation, cultural factors, and lack of resources. Cytology-based screening requires multiple visits to complete the process from screening to treatment. Screen-and-treat regimens based on visual inspection with acetic acid or human papillomavirus requiring 1 or 2 visits have the potential to improve cervical cancer prevention in the USAPI. Conclusions: The standard US algorithm of cytology screening followed by colposcopy and treatment is less effective in geographically and culturally isolated regions such as the USAPI. Alternate technologies, both high tech, such as primary human papillomavirus screening, and low tech, such as visual inspection with acetic acid, have shown promise in resource-poor countries and may have applicability in these US jurisdictions.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease

  • No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease

  • No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective The aims of the study were to define the heterogeneity of vulvodynia by determining data-driven subgroups within the vulvodynia diagnosis using exploratory cluster analysis and to characterize the subgroups identified. Materials and Methods Included were participants in the longitudinal population-based study of vulvodynia in southeast Michigan who screened positive for vulvodynia at least once during the study. A cluster analysis using variables reflecting vulvar pain characteristics and comorbid pain conditions was conducted. Variables reflecting best separation of clusters were used to assign participants to subgroup categories. Demographic, psychiatric, general health, and other vulvar pain characteristics were summarized for each subgroup, followed by multinomial regression and pairwise comparisons of subgroups on these factors. Results Of 441 women screening positive for vulvodynia during the course of the study, 393 were eligible on the basis of data requirements. Cluster analysis suggested that best subgroup separation was based on the following 2 variables: (1) presence or absence of spontaneous vulvar pain and (2) presence or absence of other comorbid pain conditions. Subgroups did not differ by age or ethnicity. The subgroup having spontaneous pain and other comorbid conditions demonstrated greatest morbidity in general health measures, psychiatric disorders, and other vulvar pain measures. Primary versus secondary vulvodynia did not vary between subgroups and did not assist in subgroup separation in the cluster analysis. Discussion Subgroups based on exploratory cluster analysis demonstrated that presence of spontaneous pain and the presence of comorbid pain conditions resulted in best separation of groups. Presence of both spontaneous pain and other comorbid pain conditions identified the group with greatest morbidity.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The aim of the study was to assess the clinicopathological characteristics of patients with verrucous carcinoma (VC) of the vulva. Materials and Methods: We reviewed data on the age, disease course, clinical manifestation, pathologic diagnosis, treatment, and follow-up of patients with vulvar VC who were treated at Tianjin Medical University General Hospital and cases that were reported in the Chinese and English literature during the past 20 years. Results: Six cases were identified in Tianjin Medical University General Hospital, the mean age of patients was 55 years, and their mean disease course was 26 months. Primary symptoms were exophytic neoplasm with pruritus and/or pain. Surgical treatment included wide local excision, simple vulvectomy, and radical vulvectomy with or without lymph node dissection in the groin. Vulvar VC occurred simultaneously with vulvar intraepithelial neoplasia in 2 cases and well-differentiated squamous cell carcinoma in 2 cases. The mean follow-up was 16.8 months with no recurrence in those 6 cases. During the 20-year period, 20 and 41 cases were reported in Chinese and English literature, respectively. Three cases were misdiagnosed with giant condyloma acuminatum in China. One case (1/20) was reported with coexistent squamous carcinoma in Chinese literature and 8 cases (8/41) in the English literature. The recurrence rate was 12.5% (2/19) and 17.5% (7/40) in Chinese and English literature, respectively. Conclusions: Vulvar VC is a distinct type of slow-growing, nonmetastatic tumor with unclear etiology. These tumors should be distinguished from giant condyloma acuminatum and well-differentiated squamous cell carcinoma. Surgery is the most effective treatment.
    No preview · Article · Jan 2016 · Journal of Lower Genital Tract Disease