(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n= 86), VaIN I/vLSIL (n= 116), VaIN II/vHSIL (n= 41), VaIN III/vHSIL (n= 33), and carcinoma (n= 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II/III/vHSIL threefold. The detection rate for VaIN III/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II/III/vHSIL.
（1）背景：阴道上皮内瘤变（VaIN）是一种由持续人乳头瘤病毒（HPV）感染引起的罕见癌前病变。其诊断具有挑战性；异常细胞学检查和HPV阳性检测通常是首要指征，但现有关于二者检测准确性的数据稀少且存在矛盾。本研究旨在比较高危型HPV与细胞学联合检测结果与阴道组织学检查结果的一致性。（2）方法：在埃尔朗根大学医院认证的异型增生诊疗中心，收集2015年至2023年间取自子宫颈或子宫切除术后阴道壁的细胞学及HPV检测样本，并与阴道壁活检组织学结果进行关联分析。排除无阴道活检结果或合并宫颈病变的患者。（3）结果：共纳入209名女性的279次阴道镜检查。组织学结果显示：良性病变（86例）、VaIN I/阴道低度鳞状上皮内病变（116例）、VaIN II/阴道高度鳞状上皮内病变（41例）、VaIN III/阴道高度鳞状上皮内病变（33例）及癌变（3例）。既往子宫切除术女性的VaIN检出准确率更高。阴道镜检查期间HPV阳性结果使VaIN II/III/阴道高度鳞状上皮内病变的检出概率增加三倍。子宫切除术后VaIN III/阴道高度鳞状上皮内病变检出率为50%，未切除子宫者为36.4%。（4）结论：对于具有VaIN高危因素（包括HPV-16感染或既往HPV相关病史）的女性，需对完整阴道壁进行细致评估。因HPV相关疾病行子宫切除术及宫颈上皮内瘤变（CIN）病史也会增加VaIN II/III/阴道高度鳞状上皮内病变的风险。
肿瘤(癌症)患者之家