Colposcopic patterns of vaginal intraepithelial neoplasia: a study from the Italian Society of Colposcopy and Cervico-Vaginal Pathology

Abstract

The aim of this study was to evaluate the colposcopic patterns observed in women with a histopathological diagnosis of vaginal intraepithelial neoplasia (VaIN). The medical charts and the colposcopy records of women diagnosed with VaIN from January 1995 to December 2013 were analysed in a multicentre retrospective case series. The abnormal colposcopic patterns observed in women with VaIN1, VaIN2 and VaIN3 were compared. The vascular patterns and micropapillary pattern were considered separately. A grade II abnormal colposcopic pattern was more commonly observed in women with a biopsy diagnosis of VaIN3 rather than with VaIN1 or VaIN2 (P<0.001). Vascular patterns were also more common in women with VaIN3 rather than with VaIN1 or VaIN2 (P<0.001). Moreover, in women with grade I colposcopy, the rate of VaIN3 was significantly higher when a vascular pattern was observed (62.5 vs. 37.5%; P=0.04). The micropapillary pattern was more common in women with grade I colposcopy and it was more frequently observed in women with VaIN1 rather than in those with VaIN2 or VaIN3 (P<0.001). Grade II abnormal colposcopic pattern was more commonly observed in women with VaIN3. Moreover, the detection of vascular patterns appeared to be associated with more severe disease (VaIN3) even in women with grade I colposcopy, whereas the micropapillary pattern should be considered an expression of a less severe disease (VaIN1 and VaIN2).

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

“…These results may provide a basis for the implementation of the IFCPC colposcopic terminology of the vagina but are different from Sopracordevole's opinion, in which Lugol's non-staining was considered a grade 1 abnormal colposcopy. 9 The micropapillary pattern, not included in the 2011 IFCPC terminology, seems to be associated with VaIN in some studies. 9,18 This colposcopic pattern is quite rare in the cervix but seems to be relatively common on the vaginal epithelium.…”

“…This pattern was associated with less severe disease, and it could probably be an expression of a persistent HPV infection, which is consistent with Sopracordevole's opinion. 9 However, further studies clarifying this assessment are needed.…”

“…7 Low-grade VaIN has a high rate of spontaneous regression and a low risk of progression to malignancy, while high-grade VaIN has a high risk of recurrence and progression to invasive vaginal cancer. [8][9][10][11] For VaIN, different lesions require different therapeutic approaches; thus, a proper diagnosis is important. Since VaIN is often asymptomatic, its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically guided biopsy of suspicious areas.…”

“…Boonlikit and Indraccolo analysed the consistency between colposcopic patterns of VaIN and histopathology and showed that vaginal colposcopy poorly predicted the severity of vaginal lesions. 9,13,14 Worldwide, there was no uniform standard for colposcopic findings of VaIN until the International Federation for Cervical Pathology and Colposcopy (IFCPC) revised the colposcopic nomenclature in 2011, in which the colposcopic terminology for the vagina was included for the first time. 15 The nomenclature provides standardized interpretations of the colposcopic findings of vaginal lesions and organizes a comprehensive classification system.…”

“…Clinical evaluation studies on the applicability of the 2011 IFCPC terminology for the vagina are extremely scant. 9,16 The aim of this study was to evaluate the application of the 2011 IFCPC terminology on the detection of VaIN. In this study, we analysed the colposcopic accuracy and significance of individual findings according to the 2011 IFCPC classification.…”