Journal of Lower Genital Tract Disease最新文献

{"title":"Immunocompetency Status and Its Association With Multicentric Lower Anogenital Tract Dysplasia.","authors":"Nikka Khorsandi, Peyman Samghabadi, Cynthia Gasper","doi":"10.1097/LGT.0000000000000914","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000914","url":null,"abstract":"<p><strong>Objective: </strong>Multicentric, human papillomavirus (HPV) associated lower genital tract disease includes preinvasive and invasive lesions at multiple anatomic sites and can be synchronous or metachronous. Identifying patients with multicentric disease is crucial because of associated high treatment failure and recurrence. This study evaluates clinicopathologic patterns in immunocompetent and immunocompromised patients with multicentric lower anogenital disease.</p><p><strong>Materials and methods: </strong>Two-hospital retrospective study of 36 patients with histologic diagnoses of multicentric anogenital HPV-associated dysplasia was identified over a 25-year period. Patients were classified based on immune status: immunocompetent without HIV, immunocompetent with HIV, and immunocompromised. Histologic diagnoses, p16 immunohistochemistry (IHC), and in situ hybridization (ISH) for high-risk (HR) and low-risk (LR) HPV were reviewed.</p><p><strong>Results: </strong>The most common sites of dysplasia were the anus (25%) and vulva (25%), with high-grade squamous intraepithelial lesions (HSIL) being the most frequent diagnosis (50%). Positive p16 IHC and HR-HPV ISH staining occurred in 71% and 81% of specimens, respectively. One-third of patients revealed a variation in IHC/ISH expression in lesions at the same anatomic sites at different time points. A significantly higher frequency of variation occurred in individuals living with HIV and immunocompromised individuals when compared to immunocompetent individuals.</p><p><strong>Conclusions: </strong>This study supports the theory that some multicentric disease may arise from repeated infections with various HPV genotypes. The findings highlight the need for further research into genetic predispositions and other factors influencing the development of multicentric HPV-associated lesions in both immunocompetent and immunocompromised individuals.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apremilast Versus Placebo for Genital Erosive Lichen Planus in Women: A Randomized Controlled Trial.","authors":"Kristin Helene Skullerud, Petter Gjersvik, Are Hugo Pripp, Erik Qvigstad, Siri Vangen, Anne Lise Ording Helgesen","doi":"10.1097/LGT.0000000000000915","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000915","url":null,"abstract":"<p><strong>Objectives: </strong>We set out to evaluate the efficacy and safety of phosphodiesterase-4 inhibitor apremilast for moderate-to-severe genital erosive lichen planus (GELP) in women.</p><p><strong>Materials and methods: </strong>In this randomized, double-blinded, placebo-controlled trial, women with moderate-to-severe GELP received either 30-mg apremilast tablets twice daily, or placebo tablets, for 24 weeks. According to pretrial power calculations, the study needed 40 participants to demonstrate a meaningful clinical effect. Efficacy was evaluated using a clinical scoring tool (GELP score). The primary endpoint was GELP scores at week 24 assessed by an Analysis of covariance model adjusted for baseline values. Secondary endpoints included Female Sexual Distress Scale-revised and Dermatology Life Quality Index scores.</p><p><strong>Results: </strong>A total of 37 women with mean age 57.5 years and a mean GELP score of 14.2 were randomized to receive either apremilast (n = 19) or placebo (n = 18). In an intention-to-treat analysis at week 24, mean GELP score was 11.6 in the apremilast group and 11.6 in the placebo group with mean difference between the 2 groups being -0.4 (95% CI = -2.7 to 1.9; p = .71). No significant differences in the secondary endpoints, including Female Sexual Distress Scale-revised and Dermatology Life Quality Index scores, were observed. The per protocol analyses with 14 and 15 participants in each group revealed similar results. Adverse events were registered in 36 women, including serious adverse events in 2 women in the apremilast group.</p><p><strong>Conclusions: </strong>Although having a small sample size, this randomized controlled trial did not reveal any signals indicating a clinical effect from apremilast treatment in women with moderate-to-severe GELP.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An eDelphi Consensus on Key Questions for a Vulvar Health Clinic Intake Questionnaire.","authors":"Jennifer Foster, Olivia Negris, Olivia Abraham, Christina Kraus, Alicia J Little, Avni Patel, Olushola L Akinshemoyin Vaughn, Melissa M Mauskar","doi":"10.1097/LGT.0000000000000919","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000919","url":null,"abstract":"<p><strong>Objective: </strong>Vulvar health conditions such as lichen sclerosus and vulvodynia are often misdiagnosed or delayed in diagnosis, leading to worsened clinical outcomes. A standardized intake questionnaire for the initial patient visit could improve early detection and management of these complex conditions. This study aimed to develop a consensus-based standardized intake questionnaire for vulvar health clinics using the eDelphi methodology.</p><p><strong>Materials and methods: </strong>An international eDelphi process was initiated. Specialists in vulvar health were recruited to participate in 2 rounds of online surveys to achieve consensus on key questions. The consensus was defined as 70% agreement among panelists for inclusion or exclusion of questions, with feedback incorporated between rounds.</p><p><strong>Results: </strong>A total of 80 panelists from various specialties, including dermatology and gynecology, participated. In the first round, 136 items were reviewed, with 64 meeting consensus for inclusion. After the second round, an additional 20 items were added, leading to a final intake questionnaire consisting of 82 items that were condensed and reorganized to 52 questions and 2 validated surveys (the Vulvar Quality of Life Index and Patient Health Questionnaire 2).</p><p><strong>Conclusions: </strong>This study successfully identified key questions for a standardized intake questionnaire for vulvar health clinics using the eDelphi methodology. The methodology may also be applicable to other health conditions requiring structured patient intake processes.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Adherence to Colposcopy Guidelines on the Detection of Cervical Intraepithelial Neoplasia.","authors":"Jessica R Fine, Claire M Bartel, Simone T Conde, Badr A Abdullah, Felicia L Hamilton","doi":"10.1097/LGT.0000000000000918","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000918","url":null,"abstract":"<p><strong>Objectives: </strong>Practice recommendations for the minimum steps to perform a colposcopy were published in 2017. The goals of this study are to assess if adherence to these guidelines correlates with detection of cervical intraepithelial neoplasia and to analyze factors associated with rates of biopsy during colposcopy.</p><p><strong>Materials and methods: </strong>All colposcopies performed at 2 academic medical centers between 2018-2023 were identified by billing code. Patient demographics, cervical cancer screening, medical history, colposcopy details, and pathology were collected from retrospective medical record review. Adherence to guidelines was determined by the number of criteria met on colposcopy documentation. The outcomes assessed were grade of pathology and rate of biopsy.</p><p><strong>Results: </strong>In univariable regression analysis, no association between adherence to guidelines and detection of cervical intraepithelial neoplasia 2+ was identified (odds ratio [OR] = 1.11, p = .12). When controlling for race, ethnicity, insurance type, Pap test cytology, and human papillomavirus vaccination status in multivariate analysis, there remained no statistically significant correlation (adj. OR = 1.11, p = .14).Black patients (OR = 0.66, p = .039), publicly insured patients (OR = 0.38, p < .001), and patients with HIV (OR = 0.39, p < .001) were each significantly less likely to have a biopsy taken during colposcopies compared to White, privately insured patients, or HIV-negative patients. In multivariate analysis, HIV and public insurance remained factors associated with lower rates of biopsy (adj. OR = 0.46, p < .001 and adj. OR = 0.63, p = .035, respectively).</p><p><strong>Conclusions: </strong>The study found insufficient evidence to support current colposcopy guidelines. The analysis revealed disparities in the execution of biopsies during colposcopies, particularly in Black, publicly insured, and HIV-positive patients, underscoring the importance of standardization of colposcopic practices.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Cervical or Vaginal HPV Testing in Surveillance of Vulvar, Vaginal, and Anal HPV-Associated Neoplasia.","authors":"Elloise Smith, Tania Day","doi":"10.1097/LGT.0000000000000920","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000920","url":null,"abstract":"<p><strong>Objectives: </strong>The study aims are to evaluate the utility of cervical or vaginal human papillomavirus (HPV) status in predicting recurrence of noncervix lower genital tract (LGT) high-grade squamous intraepithelial lesion (HSIL), assess factors associated with HPV positivity, and explore patterns of HSIL surveillance.</p><p><strong>Methods: </strong>This retrospective cohort included patients undergoing ≥12 months of surveillance after biopsy-proven vulvar, vaginal, or anal HSIL between 2015 and 2023 at an Australian hospital with a laboratory that performs universal p16 and p53 immunohistochemistry for vulvar squamous neoplasia. Data collected included demographics, HPV results, medical comorbidities, vulvar dermatoses, treatment, frequency of surveillance, outcomes, and follow-up duration. Data were stratified by HPV status at the time of LGT HSIL diagnosis.</p><p><strong>Results: </strong>Of 143 patients with a median age of 54 years, 23% used topical steroids for lichen sclerosus or planus, 93% had a recent or concurrent HPV test, and 53% of these were positive. Positive HPV was more frequent in vaginal versus vulvar HSIL (92% vs 46%; p = .003) and less frequent in patients with diabetes (23% vs 3%; p < .001). Recurrent or persistent HSIL occurred in 65%. HPV positivity was not associated with overall recurrence, but afforded a 6-fold higher vaginal HSIL recurrence risk. There was a documented surveillance strategy in 92% with 78% of these having 6-monthly assessments for 5 disease-free years, then annually.</p><p><strong>Conclusions: </strong>Cervical or vaginal oncogenic HPV results do not predict vulvar HSIL recurrence but may inform surveillance for vaginal disease. Limitations include the retrospective design, potential referral bias, and limited generalizability.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Prediction Model for Anal High-Grade Squamous Intraepithelial Lesions Risk.","authors":"Cintia M S Kimura, Caio Rizkallah Nahas, Vinicius Ribeiro, Sergio Nahas, Benjamin T Davis, Michelle Khan","doi":"10.1097/LGT.0000000000000913","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000913","url":null,"abstract":"<p><strong>Objective: </strong>Timely treatment of anal high-grade intraepithelial lesions (HSIL) prevents progression to anal cancer. Available screening tools (anal Pap test and high-risk human papillomavirus testing) have inconsistent and suboptimal performance, often leading to overreferral to high-resolution anoscopy, the gold standard test for HSIL diagnosis. We aimed to develop and externally validate a clinical prediction model for histologic HSIL to improve triage to high-resolution anoscopy among individuals at increased risk for anal cancer.</p><p><strong>Materials and methods: </strong>Medical records from 2 institutions were reviewed to identify candidate predictors of histologic HSIL. A penalized logistic regression model with elastic net regularization was developed and internally validated with five-fold cross-validation. External validation was performed in a third institution cohort. Candidate predictors were age, sex, HIV status, history of anogenital HPV-related disease, immunosuppressant use, anal cytology, anal high-risk HPV (hrHPV) status, and interaction terms (HIV status*hrHPV infection) and (HIV status*history of anogenital HPV-related disease).</p><p><strong>Results: </strong>The derivation dataset included 536 patients, 382 (71.3%) were people living with HIV, 168 (31.3%) were women, and HSIL prevalence was 21.1%. The area under the ROC on the derivation dataset was 0.80 (95% CI = 0.69; 0.90). The external validation dataset included 242 patients, 159 (65.7%) people living with HIV, 18 (7.4%) women, with HSIL prevalence of 37.2%. The final model included age, sex, anal cytology, anal hrHPV, immunosuppressant use, history of anogenital HPV-associated disease, and the 2 interaction terms. The area under the receiver operating characteristic (ROC) on the external validation dataset was 0.73 (95% CI = 0.67; 0.80).</p><p><strong>Conclusions: </strong>This clinical prediction model demonstrated a promising performance and included objective factors that are easily obtained.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Vulvar Self-examination Performance in a Population at Increased Risk of Vulvar Cancer.","authors":"Jaime Reardon, Jessie Tu, Amanda Selk","doi":"10.1097/LGT.0000000000000916","DOIUrl":"https://doi.org/10.1097/LGT.0000000000000916","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate if a teaching session and optional reminders improved frequency of performance of vulvar self-examination (VSE) in a population at increased risk of vulvar cancer.</p><p><strong>Materials and methods: </strong>Participants were recruited from Colposcopy and Vulvar Dermatology clinics at a publicly funded academic hospital in Ontario, Canada. Participants completed a questionnaire, were taught how to perform a VSE, and given an information booklet. They had the option to receive phone or electronic health record reminders to complete a VSE over the course of the next 6 weeks. After 6 weeks, participants were contacted to survey their VSE behaviors. Data were analyzed using descriptive statistics.</p><p><strong>Results: </strong>Two hundred nineteen participants completed the study. Prior to the study, 28 participants (13%) had heard of VSE, while 31 (14%) had never looked at their external genitalia before. At a 6-week follow-up, 181 out of 219 participants (83%) completed a VSE, compared to 16% who regularly performed VSEs prior to the intervention (p < .001). There was a statistically significant improvement in self-reported ability to find the labia minora, labia majora and urethra after the intervention.</p><p><strong>Conclusions: </strong>Despite low baseline levels of familiarity with VSE, a simple teaching session, with or without reminders was associated with high performance of VSE in a population at increased risk of vulvar cancer.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vulvovaginal Candidiasis Caused by Candida krusei (Pichia kudriavzevii ), Still a Formidable Challenge.","authors":"Yogitha Sai Vempati, Jack D Sobel","doi":"10.1097/LGT.0000000000000899","DOIUrl":"10.1097/LGT.0000000000000899","url":null,"abstract":"<p><strong>Objectives: </strong>In recent years, the prevalence of non -albicans Candida vulvovaginitis has risen with Candida glabrata and Candida krusei ( Pichia kudriavzevii ) being prominent contributors. Candida krusei poses a significant challenge due to its intrinsic resistance to fluconazole, both in vitro and clinically. Practitioners face difficulties managing patients with chronic symptomatic vulvovaginal candidiasis who fail to respond to multiple courses of oral fluconazole and over the counter (OTC) antifungals.</p><p><strong>Methods: </strong>The authors analyzed retrospectively a cohort of women who had chronic vulvovaginal symptoms seen in their vaginitis clinic between 2017 and 2024. Clinical charts of 11 patients with positive C. krusei vaginal fungal isolates were reviewed. Antifungal susceptibility of isolates was assessed, and treatments, including novel antifungal agents oteseconazole and ibrexafungerp, were evaluated for their efficacy in symptom control.</p><p><strong>Results: </strong>In 10 of 11 patients, symptoms were attributed to C. krusei vaginitis, while in 1 patient, C. krusei was found to be an innocent bystander. Candida krusei vaginal isolates in vitro susceptibility testing demonstrated resistance not only limited to fluconazole but also to miconazole, ketoconazole, and other azole agents. Although itraconazole exhibited in vitro activity, treatment often failed to achieve clinical or mycologic remission. Despite the availability of new antifungal agents, vaginal boric acid emerged as the initial if not definitive treatment method of choice.</p><p><strong>Conclusion: </strong>Determining the antifungal susceptibility profile of C. krusei vaginal isolates may be required in selecting effective antifungal treatment of refractory vaginitis due to non -albicans Candida (NAC).</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"373-375"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Morpho-Functional Assessment of the Vulvar Vestibule in Patients With Vestibulodynia: A Case-Control Study.","authors":"Filippo Murina, Cecilia Fochesato, Stefania Di Francesco, Dario Recalcati, Giovanna Esposito, Valeria Savasi","doi":"10.1097/LGT.0000000000000904","DOIUrl":"10.1097/LGT.0000000000000904","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to investigate the morpho-functional characteristics of the vulvar vestibule in women with provoked vestibulodynia (PVD), comparing clinical, structural, and sensory parameters with healthy controls.</p><p><strong>Methods: </strong>This was a case-control study including 30 women diagnosed with PVD and 30 healthy controls. The following morpho-functional characteristics were considered: (i) vestibular trophism, (ii) vestibular epithelial thickness, (iii) pelvic floor muscle hypertonia, and (iv) vestibular current perception threshold evaluation, at 3 frequencies (2000 Hz, 250 Hz, and 5 Hz). Fisher's exact test and Mann-Whitney U test were used to compare parameters between PVD cases and healthy controls, while Pearson's correlation coefficient was calculated to assess vestibular trophism and epithelial thickness with neurosensitization.</p><p><strong>Results: </strong>PVD patients compared to healthy controls showed higher vestibular trophism health score (6.5 vs 3.0, p < .001), lower epithelial thickness (987.0 vs 1,159.0 μm, p < .001), more frequently hypertonia of pelvic floor muscle ( p < .001), and lower thresholds at neurosensitization at all three frequencies. A linear negative correlation emerged between vestibular trophism health score and current perception threshold at 5 Hz (r = -0.53, p = .003) and 250 Hz (r = -0.45, p = .013) in PVD cases. No significant correlation emerged for controls and for both groups for current perception threshold at 2000 Hz.</p><p><strong>Conclusions: </strong>This study identified substantial organic differences between PVD patients and healthy controls in critical parameters, such as vestibular trophism, epithelial thickness, pelvic floor muscle hypertonia, and neurosensitization. These findings enhance understanding of the complex and multifactorial mechanisms underlying PVD and highlight potential therapeutic targets for intervention.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"380-386"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver Variation in Vulvar Squamous Cell Cancer Depth of Invasion Using Two Measurement Methods.","authors":"Jesse Carroll, Tania Day, Jill Allbritton, Mariacristina Ghioni, Debra Heller, Marsali Newman, Eleonora Petra Preti, Mario Preti, Maria Angelica Selim, Stephanie L Skala, Deborah Smith, Daniele Tota, Rachael van der Griend, James Scurry","doi":"10.1097/LGT.0000000000000909","DOIUrl":"10.1097/LGT.0000000000000909","url":null,"abstract":"<p><strong>Objectives: </strong>Depth of invasion (DOI) in vulvar squamous cell carcinoma (vSCC) predicts risk of nodal metastasis, with measurement >1 mm dictating the need for lymph node diagnostic procedures. In 2021, the International Federation of Gynecology and Obstetrics (FIGO) changed its advice on how pathologists measure DOI. Some organizations revised guidelines to this \"New\" method; others continued to endorse the FIGO 2009 \"Old\" method. This study compares interobserver variation of vSCC DOI using Old and New FIGO measurement strategies.</p><p><strong>Methods: </strong>A single representative image was chosen from 50 consecutive vSCC excisions with reported DOI of 0.1-3 mm. Ten pathologists provided 2 electronic measurements for each, using Old and New methods. Statistical evaluation included analyses of variance, Student t -test, and the kappa statistic.</p><p><strong>Results: </strong>The Old method yielded a larger mean DOI than the New [1.3 vs 0.9 mm; p < .001]. The Old method had a lower proportion of measurement disagreements spanning 1 mm (53%, κ = 0.65% vs 68%, κ = 0.6). Agreement by all pathologists of DOI being either ≤1 mm or >1 mm occurred in 29/50 cases (58%) using the Old and 26 (52%) using the New method. When at least 2 pathologists measured DOI >1 mm, interobserver variation was lower using the Old method in 30 (83%) of 36 cases [mean difference = -0.1 mm, t (280) = -2.78, p = .008].</p><p><strong>Conclusions: </strong>The FIGO 2021 DOI measurement method has higher interobserver variation than FIGO 2009, with this difference arising from tumors with DOI >1 mm. This finding, combined with inadequate international consensus and scant clinical outcome data, should trigger reconsideration of 2021 FIGO staging guidelines.</p>","PeriodicalId":50160,"journal":{"name":"Journal of Lower Genital Tract Disease","volume":" ","pages":"304-309"},"PeriodicalIF":2.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}