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

Mario Preti, Lauro Bucchi, Bruno Ghiringhello, Silvana Privitera, Valentina Frau, Elisabetta Corvetto, Chiara Benedetto, Leonardo Micheletti

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article numbere57
JournalJournal of Gynecologic Oncology
Volume28
Issue number4
DOIs
Publication statusPublished - Jan 1 2017

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Carcinoma
Biopsy
Vulvar Diseases
Squamous Intraepithelial Lesions of the Cervix
Logistic Models
Cervical Intraepithelial Neoplasia
Tertiary Care Centers
Italy
Multivariate Analysis

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy. / Preti, Mario; Bucchi, Lauro; Ghiringhello, Bruno; Privitera, Silvana; Frau, Valentina; Corvetto, Elisabetta; Benedetto, Chiara; Micheletti, Leonardo.

In: Journal of Gynecologic Oncology, Vol. 28, No. 4, e57, 01.01.2017.

Research output: Contribution to journalArticle

Preti, Mario ; Bucchi, Lauro ; Ghiringhello, Bruno ; Privitera, Silvana ; Frau, Valentina ; Corvetto, Elisabetta ; Benedetto, Chiara ; Micheletti, Leonardo. / Risk factors for unrecognized invasive carcinoma in patients with vulvar high-grade squamous intraepithelial lesion at vulvoscopy-directed biopsy. In: Journal of Gynecologic Oncology. 2017 ; Vol. 28, No. 4.
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AU - Bucchi, Lauro

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AU - Privitera, Silvana

AU - Frau, Valentina

AU - Corvetto, Elisabetta

AU - Benedetto, Chiara

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