J Gynecol Oncol.  2017 Jul;28(4):e27. 10.3802/jgo.2017.28.e27.

Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy

• Preti M
• Bucchi L
• Ghiringhello B
• Privitera
• Frau V
• Corvetto E
• Benedetto
• Micheletti L

• KMID: 2413422
• DOI: http://doi.org/10.3802/jgo.2017.28.e27

Abstract

OBJECTIVE
To evaluate the prevalence and risk factors for unrecognized invasive carcinoma in a series of patients undergoing surgical excision after an office biopsy of vulvar high-grade squamous intraepithelial lesion (VHSIL).
METHODS
Two hundred and sixteen consecutive patients treated in a tertiary-level referral center for vulvar disease in north-western Italy were recruited. Patients' records were reviewed by trained personnel. Factors showing a statistically significant (p<0.05) association with detection of stromal invasion at excisional surgery in univariate analysis were further examined in a backward stepwise multiple logistic regression model.
RESULTS
The median patient age was 50 years (range, 19-88). More than 25% patients with VHSIL at biopsy had associated cervical/vaginal intraepithelial neoplasia, and more than 35% had a multifocal lesion. Invasive carcinoma was detected in surgical specimens from 24 patients (11%). The depth of stromal invasion varied between 0.1 mm and 3.0 mm with a median of 0.5 mm. In multivariate analysis, the risk of invasive carcinoma detection was greater for patients in the highest tertile of age (p=0.008), for patients with a lesion ≥20 mm in size (p=0.013) and with clitoral involvement (p<0.001), and for patients presenting with a nodular lesion (p=0.078).
CONCLUSION
Our study suggests that patient age, lesion size, clitoral involvement and nodular appearance in patients with VHSIL at vulvoscopy-directed biopsy are independently associated with the risk of unrecognized invasive carcinoma.

Keyword

Biopsy; Vulvar Neoplasms; Vulvar High-grade Squamous Intraepithelial Lesion; Vulvoscopy

MeSH Terms

Adult
Age Factors
Aged
Aged, 80 and over
Biopsy
Carcinoma/*diagnosis/*pathology
Cervical Intraepithelial Neoplasia/diagnosis/pathology
Clitoris/pathology
Female
Humans
Middle Aged
Neoplasm Invasiveness
Neoplasms, Multiple Primary/*diagnosis/pathology
Retrospective Studies
Risk Factors
Tumor Burden
Uterine Cervical Neoplasms/*diagnosis/pathology
Vulva/pathology
Vulvar Neoplasms/*diagnosis/*pathology/surgery
Young Adult