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Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Malignancies of the vagina are rare, but colposcopy-directed biopsies play a major role in detecting vaginal intraepithelial lesions. Data of accuracy in detecting neoplasia of the vagina are very rare compared to accuracy in detecting cervical neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with clinical findings of the examiner.

Methods

The accuracy of colposcopy-directed biopsy was compared with the clinical finding in relation to the patient’s age and the examiner’s level of training. This was done in combination with PAP-smear, HPV-test results, and the history of other malignancies of the lower genital tract. The data were collected between January 2014 and February 2018 at the certified Dysplasia Unit of the University Hospital Erlangen.

Results

In total, 253 biopsies from 253 women from the vagina were obtained. The overall accuracy of biopsy in comparison with clinical finding was 52.17% for all entities—benign lesions, low-grade squamous intraepithelial lesions (LSILs), high-grade squamous intraepithelial lesions (HSILs), and vaginal carcinoma. The accuracy for detecting HSIL was 82.46% (47/57), with an underdiagnosis rate of 15.79% and an overdiagnosis rate of 1.79%.

Conclusion

With a sensitivity of over 80%, colposcopy-directed biopsy plays an important role in detecting vaginal–HSIL. A highly experienced practitioner is increasing the sensitivity in detecting vaginal–HSIL. Careful examination is required in women with a history of HSIL of the lower genital tract or with simultaneous neoplasia because they are of greater risk of developing vaginal malignancies. The combination of careful clinical work up, PAP-smear, HPV-testing, and colposcopy-guided biopsy is crucial in detecting vaginal–HSIL.

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Author information

Author notes

  1. Frederik A. Stuebs and Martin C. Koch contributed equally.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Universitaetsstrasse 21-23, 91054, Erlangen, Germany

    Frederik A. Stuebs, Martin C. Koch, Grit Mehlhorn, Paul Gass, Carla E. Schulmeyer, Matthias W. Beckmann & Simone K. Renner

  2. Department of Gynecology and Obstetrics, Klinikum Sindelfingen-Böblingen, Bunsenstraße 120, 71032, Böblingen, Germany

    Simone K. Renner

  3. Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER-EMN), Krankenhausstraße 8-10, 91054, Erlangen, Germany

    Arndt Hartman

  4. Department of Gynecology and Obstetrics, Fürth, Klinikum Fürth, Jakob-Henle-Straße 1, 90766, Fürth, Germany

    Johanna Strehl

  5. Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Waldstraße 6, 91054, Erlangen, Germany

    Werner Adler

Authors
  1. Frederik A. Stuebs
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  2. Martin C. Koch
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  3. Grit Mehlhorn
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  4. Paul Gass
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  6. Arndt Hartman
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  7. Johanna Strehl
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  8. Werner Adler
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  9. Matthias W. Beckmann
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  10. Simone K. Renner
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Contributions

FAS, MCK, MWB: Protocol/project development, Manuscript writing/editing. FAS, MCK, CES, GM, PG, AH and SKR: Data collection or management. FAS, MCK, MWB, WA, JS: Data analysis.

Corresponding author

Correspondence to Frederik A. Stuebs.

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Conflict of interest

P. Gass has received honoraria from Novartis, financial support for symposia from Novartis, Roche, and PharmaMar, and reimbursement of travel expenses from the discovering hands® company. None of the other authors have any conflicts of interest. Completed disclosure of conflict of interest forms are available for viewing online as supporting information.

Ethical approval

Approval for the study was obtained from the ethics committee of the Faculty of Medicine at Friedrich Alexander University of Erlangen-Nuremberg. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.Sources of funding support: no funding was received for this study.

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Stuebs, F.A., Koch, M.C., Mehlhorn, G. et al. Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: a retrospective study. Arch Gynecol Obstet 301, 769–777 (2020). https://doi.org/10.1007/s00404-020-05441-5

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  • DOI: https://doi.org/10.1007/s00404-020-05441-5

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