Cytology of the vulva: feasibility and preliminary results of a new brush

Abstract

Objective: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.Methods: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.Results: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%.Conclusion: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.

Defining benchmarks for tolerable risk thresholds in cancer screening: Impact of HPV vaccination on the future of cervical cancer screening

“…As a result, performance could be even better compared to cervical screening using cytology. 20 While a higher proportion of vulvar lesions may be attributed to HPV among younger patients, 21 we do not expect that performance of cytology screening would differ according to HPV status.…”

“…As a result, performance could be even better compared to cervical screening using cytology. 20 While a higher proportion of vulvar lesions may be attributed to HPV among younger patients, 21 In addition to providing excellent protection against cervical cancer, we also expect a reduction in the incidence of vulvar cancer due to vaccination. Approximately 25% of vulvar cancer cases globally are attributable to HPV 24 and among these cases, approximately 90% are caused by the seven oncogenic HPV types targeted by Gardasil 9.…”