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.

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

PRETI, MARIO
First
;
Ghiringhello, Bruno;FRAU, Valentina;CORVETTO, ELISABETTA;Benedetto, Chiara;Micheletti, Leonardo
Last
2017-01-01

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.
2017
28
4
e27
e27
https://www.ejgo.org/Synapse/Data/PDFData/1114JGO/jgo-28-e27.pdf
Biopsy; Vulvar High-grade Squamous Intraepithelial Lesion; Vulvar Neoplasms; Vulvoscopy; Adult; Age Factors; Aged; Aged, 80 and over; Biopsy; Carcinoma; Cervical Intraepithelial Neoplasia; Clitoris; Female; Humans; Middle Aged; Neoplasm Invasiveness; Neoplasms, Multiple Primary; Retrospective Studies; Risk Factors; Tumor Burden; Uterine Cervical Neoplasms; Vulva; Vulvar Neoplasms; Young Adult; Oncology; Obstetrics and Gynecology
Preti, Mario*; Bucchi, Lauro; Ghiringhello, Bruno; Privitera, Silvana; Frau, Valentina; Corvetto, Elisabetta; Benedetto, Chiara; Micheletti, Leonardo
File in questo prodotto:
File Dimensione Formato  
1114JGO_jgo-28-e27.pdf

Accesso aperto

Tipo di file: PDF EDITORIALE
Dimensione 650.82 kB
Formato Adobe PDF
650.82 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1663786
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 15
  • ???jsp.display-item.citation.isi??? 14
social impact