Clinical, Cytological, and Virological Factors Associated with Histological Severity and Recurrence in Vaginal Intraepithelial Neoplasia: A Retrospective Observational Study.
Luigi Della Corte, Mario Palumbo, Virginia Foreste, Dominga Boccia, Giuseppe Bifulco, Giada Lavitola
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引用次数: 0
Abstract
Background: Vaginal intraepithelial neoplasia (VAIN) is a rare HPV-related condition with heterogeneous behavior and a relevant recurrence risk. Factors associated with severity and recurrence remain incompletely defined.
Objective: To explore clinical, cytological, virological, and colposcopic features associated with high-grade VAIN and recurrence.
Methods: This retrospective study included 42 women with histologically confirmed VAIN at a tertiary center between January 2020 and January 2026. All underwent vaginal cytology, high-risk HPV (HR-HPV) genotyping, colposcopy, and biopsy. Histology was classified as VAIN1 or VAIN2-3. Recurrence was defined as a histologically confirmed lesion after treatment and documented disease-free assessment. Associations were assessed using bivariate and exact analyses.
Results: VAIN2-3 was diagnosed in 31 women (73.8%). Among HR-HPV-positive women, HPV16-related infection was more frequent in VAIN2-3 than VAIN1 (65.4% vs 18.2%; OR 8.50, 95% CI 1.27-91.56; p = 0.013). Cytology was associated with histological grade (p = 0.024); all women with HSIL/ASC-H had VAIN2-3, although sensitivity was limited. Over a median follow-up of 24 months, eight women (19.0%) recurred after a median of 11.5 months. HPV16-related infection was more frequent with recurrence (75.0% vs 38.2%; OR 4.85, 95% CI 0.70-54.01; p = 0.112), but the evidence was not definitive. HPV16-only infection showed borderline evidence of association (p = 0.050), while no clear outcome pattern emerged for multiple-genotype infection. No other significant associations with recurrence were observed.
Conclusion: HPV16-related infection was associated with high-grade histology among HR-HPV-positive women, while its prognostic relevance for recurrence remains uncertain. The limited sensitivity of cytology underscores the value of multimodal assessment. These exploratory signals warrant prospective validation.
背景：阴道上皮内瘤变（VAIN）是一种罕见的hpv相关疾病，具有异质性行为和相关复发风险。与严重程度和复发相关的因素仍不完全确定。目的：探讨与高度VAIN和复发相关的临床、细胞学、病毒学和阴道镜特征。方法：本回顾性研究纳入了2020年1月至2026年1月在三级中心接受组织学证实的42名女性。所有患者均接受阴道细胞学检查、高危HPV （HR-HPV）基因分型、阴道镜检查和活检。组织学分级为VAIN1或VAIN2-3。复发被定义为治疗后组织学证实的病变和无病评估记录。使用双变量和精确分析评估相关性。结果：31例女性诊断为VAIN2-3，占73.8%。在hr - hpv阳性的女性中，VAIN2-3组hpv16相关感染比VAIN1组更常见（65.4% vs 18.2%; OR 8.50, 95% CI 1.27-91.56; p = 0.013）。细胞学与组织学分级相关（p = 0.024）；所有患有HSIL/ASC-H的女性都有VAIN2-3，尽管敏感性有限。在中位随访24个月后，8名女性（19.0%）在中位11.5个月后复发。hpv16相关感染的复发率更高（75.0% vs 38.2%; OR 4.85, 95% CI 0.70-54.01; p = 0.112），但证据不明确。仅hpv16型感染显示有关联的临界证据（p = 0.050），而多基因型感染没有明确的结果模式。未观察到其他与复发的显著关联。结论：hpv16相关感染在hr - hpv阳性女性中与高级别组织学相关，但其与复发的预后相关性仍不确定。细胞学的有限敏感性强调了多模式评估的价值。这些探索性信号需要前瞻性的验证。
期刊介绍：
Journal of Investigative Surgery publishes peer-reviewed scientific articles for the advancement of surgery, to the ultimate benefit of patient care and rehabilitation. It is the only journal that encompasses the individual and collaborative efforts of scientists in human and veterinary medicine, dentistry, basic and applied sciences, engineering, and law and ethics. The journal is dedicated to the publication of outstanding articles of interest to the surgical research community.
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