Clinical Characteristics and Risk Factors to High-grade Vaginal Intraepithelial Neoplasia: a Single-institution Study

Overview

Journal BMC Womens Health

Publisher Biomed Central

Date 2025 Feb 1

PMID 39893434

Authors

Min Lu

Xiaoshan Hong

Tingyan Liu

Bi Mai

Guiying Hu

Xiaoli Sun

Affiliations

Soon will be listed here.

Abstract

Background: To date, few studies have investigated the factors associated with high-grade vaginal intraepithelial neoplasia (VaIN). This study aimed to analyze the characteristics of high-grade VaIN and identify its underlying risk factors.

Methods: This cross-sectional study included women with histologically confirmed high-grade VaIN and high-grade cervical intraepithelial neoplasia (CIN), conducted between 2017 and 2021 at a single center. Baseline clinical characteristics, human papillomavirus (HPV) infection status, cytology results, and pathology findings were analyzed using standard statistical methods.

Results: Among 1819 patients, 8.47% (154/1819) were diagnosed with high-grade VaIN (mean age: 42.1 ± 12.4 years), while 91.53% (1665/1819) had high-grade CIN (mean age: 36.7 ± 10.0 years). Older age, longer sexual life duration, higher gravidity and parity, menopause, and prior cervical treatment were identified as risk factors for high-grade VaIN (p < 0.001). High-grade VaIN was more likely to present with low-grade squamous intraepithelial lesion (LSIL) cytology among abnormal cytological results (p = 0.007). HPV was detected in 98.1% of VaIN2/3 cases (151/154), with HPV 16 being the most prevalent genotype, accounting for 39.89% (705/1767) of all infections, 36.4% of high-grade VaIN, and 39% of high-grade CIN cases. Single-genotype HPV infections were observed in 58.4% of high-grade VaIN and 64.3% of high-grade CIN, while multiple infections were found in 39.6% and 32.8%, respectively. The sensitivities of cytology for detecting high-grade VaIN and high-grade CIN were 62.3% and 69.5%, respectively (p = 0.067). HPV testing sensitivities were 98.4% and 97.1%, respectively (p = 0.578). Combined cytology and HPV testing improved sensitivities to 100% and 99.8%, respectively.

Conclusions: High-grade VaIN is significantly associated with older age. The sensitivity of cytology and HPV testing for detecting high-grade VaIN is comparable to that for high-grade CIN. Thus, these tests may facilitate early detection of high-grade VaIN.

References

Gonzalez-Bosquet E, Mazarico E, Lorente N, Gomez-Roig M . Risk factors to develop multicentric lesions of the lower genital tract. Eur J Gynaecol Oncol. 2018; 38(1):10-13. View

Zeng H, Dai Q, Jiang D . A single-institutional retrospective analysis of factors related to vaginal intraepithelial neoplasia. BMC Womens Health. 2023; 23(1):548. PMC: 10594755. DOI: 10.1186/s12905-023-02714-4. View

Ye Y, Li M, Yang W, Xu J, Wang X, Ma Y . Characteristics of high-risk HPV infection in women with vaginal intraepithelial neoplasia in Beijing, China. J Med Virol. 2023; 95(12):e29267. DOI: 10.1002/jmv.29267. View

Borgdorff H, Gautam R, Armstrong S, Xia D, Ndayisaba G, van Teijlingen N . Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier. Mucosal Immunol. 2015; 9(3):621-33. DOI: 10.1038/mi.2015.86. View

Zhang L, Wang Q, Zhang H, Xie Y, Sui L, Cong Q . Screening History in Vaginal Precancer and Cancer: A Retrospective Study of 2131 Cases in China. Cancer Manag Res. 2021; 13:8855-8863. PMC: 8631831. DOI: 10.2147/CMAR.S335701. View

Darragh T, Colgan T, Cox J, Heller D, Henry M, Luff R . The Lower Anogenital Squamous Terminology Standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Int J Gynecol Pathol. 2012; 32(1):76-115. DOI: 10.1097/PGP.0b013e31826916c7. View

Gurumurthy M, Leeson S, Tidy J, Cruickshank M . UK national survey of the management of vaginal intraepithelial neoplasia. J Obstet Gynaecol. 2019; 40(5):694-698. DOI: 10.1080/01443615.2019.1652887. View

Jhingran A . Updates in the treatment of vaginal cancer. Int J Gynecol Cancer. 2022; 32(3):344-351. PMC: 8921584. DOI: 10.1136/ijgc-2021-002517. View

Bogani G, Ditto A, Martinelli F, Mosca L, Chiappa V, Rossetti D . LASER treatment for women with high-grade vaginal intraepithelial neoplasia: A propensity-matched analysis on the efficacy of ablative versus excisional procedures. Lasers Surg Med. 2018; 50(9):933-939. DOI: 10.1002/lsm.22941. View

10.

Zhang S, Saito M, Yamada S, Sakamoto J, Takakura M, Takagi H . The prevalence of VAIN, CIN, and related HPV genotypes in Japanese women with abnormal cytology. J Med Virol. 2019; 92(3):364-371. DOI: 10.1002/jmv.25611. View

11.

Ao M, Zheng D, Wang J, Gu X, Xi M . A retrospective study of cytology and HPV genotypes results of 3229 vaginal intraepithelial neoplasia patients. J Med Virol. 2021; 94(2):737-744. DOI: 10.1002/jmv.27311. View

12.

Bogani G, Martinelli F, Ditto A, Taverna F, Lombardo C, Signorelli M . Human papillomavirus (HPV) persistence and HPV 31 predict the risk of recurrence in high-grade vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2017; 210:157-165. DOI: 10.1016/j.ejogrb.2016.12.020. View

13.

Yu D, Qu P, Liu M . Clinical presentation, treatment, and outcomes associated with vaginal intraepithelial neoplasia: A retrospective study of 118 patients. J Obstet Gynaecol Res. 2021; 47(5):1624-1630. DOI: 10.1111/jog.14733. View

14.

Tranoulis A, Laios A, Mitsopoulos V, Lutchman-Singh K, Thomakos N . Efficacy of 5% imiquimod for the treatment of Vaginal intraepithelial neoplasia-A systematic review of the literature and a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2017; 218:129-136. DOI: 10.1016/j.ejogrb.2017.09.020. View

15.

Sopracordevole F, Barbero M, Clemente N, Fallani M, Cattani P, Agarossi A . High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: a multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Eur Rev Med Pharmacol Sci. 2016; 20(5):818-24. View

16.

Bornstein J, Bentley J, Bosze P, Girardi F, Haefner H, Menton M . 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012; 120(1):166-72. DOI: 10.1097/AOG.0b013e318254f90c. View

17.

Gunderson C, Nugent E, Elfrink S, Gold M, Moore K . A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia. Am J Obstet Gynecol. 2013; 208(5):410.e1-6. DOI: 10.1016/j.ajog.2013.01.047. View

18.

Kim J, Kim J, Kim K, No J, Kim Y, Suh D . Risk Factor and Treatment of Vaginal Intraepithelial Neoplasia After Hysterectomy for Cervical Intraepithelial Neoplasia. J Low Genit Tract Dis. 2022; 26(2):147-151. PMC: 8936153. DOI: 10.1097/LGT.0000000000000664. View

19.

Zhang J, Chang X, Qi Y, Zhang Y, Zhang S . A retrospective study of 152 women with vaginal intraepithelial neoplasia. Int J Gynaecol Obstet. 2016; 133(1):80-3. DOI: 10.1016/j.ijgo.2015.08.014. View

20.

Li H, Guo Y, Zhang J, Qiao J, Geng L . Risk factors for the development of vaginal intraepithelial neoplasia. Chin Med J (Engl). 2012; 125(7):1219-23. View