Abnormal Pap Smear and Diagnosis of High-Grade Vaginal Intraepithelial Neoplasia

Abstract

The aim of this study was to analyze the correlation between the first diagnosis of high-grade Vaginal Intraepithelial Neoplasia (HG-VaIN: VaIN 2–VaIN 3) and the cytological abnormalities on the referral pap smear.All the women with histological diagnosis of HG-VaIN consecutively referred to the Gynecological Oncology Unit of the Aviano National Cancer Institute (Aviano, Italy) from January 1991 to April 2014 and with a pap smear performed in the 3 months before the diagnosis were considered, and an observational cohort study was performed.A total of 87 women with diagnosis of HG-VaIN were identified. Major cytological abnormalities (HSIL and ASC-H) on the referral pap smear were significantly more frequent than lesser abnormalities (ASC-US and LSIL) in postmenopausal women (64.9% vs 36.7%, P = .02) and in women with a previous diagnosis of HPV-related cervical preinvasive or invasive lesions (70.5% vs 39.5%, P = .01). Diagnosis of VaIN 3 was preceded by major cytological abnormalities in most of the cases (72.7% vs 27.3%, P < .001).The diagnosis of HG-VaIN can be preceded by different abnormalities on referral pap smear. Major abnormalities are usually reported in postmenopausal women and in women with previous cervical HPV-related disease. However, ASC-US or LSIL do not exclude HG-VaIN, especially VaIN2. An accurate examination of the whole vaginal walls (or vaginal vault) must be performed in all the women who underwent colposcopy for an abnormal pap smear, and a biopsy of all suspicious areas is mandatory.

Clinical analysis of cervical intraepithelial neoplasia with vaginal intraepithelial neoplasia

“…In 44.8% of the cases, however, the diagnosis of HG-VAIN was preceded by lesser cytological abnormalities. [ 11 ] These data are interesting, especially when comparing to the correlation between the CIN and the corresponding previous abnormality of cytology test. It was found that a high-grade cervical dysplasia is often preceded by major cytological abnormalities in most cases.…”

“…It has been previously reported [ 11 ] that if cytology test is abnormal, it should be followed by a subsequent colposcopy with more accurate examination of the entire lower genital tract. An accurate examination of the whole vaginal walls and vault must be performed.…”

Detection of high‐risk human papillomavirus infection and treatment of high‐grade vaginal intraepithelial neoplasia: A single‐institution study

“…Although the risk factors for VaIN are similar to those for CIN and include sexual activity, smoking, and HPV infection, little is known about VaIN as compared with other neoplasias such as CIN or VIN 7 . Several studies have investigated the prevalence of HPV infection in VaIN; however, among studies reviewed in a 2019 meta‐analysis, only one had a sample size over 300, and most focused on women who underwent hysterectomy 3,6,8‐12 . Furthermore, studies have reported conflicting findings for the rate of HPV infection among women with VaIN.…”

Post-hysterectomy rare collision vulva tumor with long-term human papilloma virus infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland

“…[11] Colposcopy and further vulvar tissue biopsy should be done if having suspicion, especially for long-term HPV infections even without vaginal dysplasia. [12] However, there is no literature mentioned that whether the vulvar tissue should be also focused, and if it is necessary for biopsy of vulvar tissue in the case of negative cytology? The current manner of cancer surveillance might be just the limitation of this case, by which long-term HPV infection has been neglected and eventually developed into a cause of vulvar tumors.…”