engleski

Accuracy of cytological diagnosis of vulvar lesions.

Objectives: Although they are easily accessible due to superficial localization, invasive lesions of the vulva are often diagnosed late. This delay is mainly due to advanced age of patients, the non-specific symptoms that are also compatible with non-neoplastic pathology and a low incidence of vulvar carcinoma. The same reasons do not justify mass screening. Vulvoscopy and tissue biopsy are commonly used for diagnosing vulvar intraepithelial and invasive lesions. Vulvoscopy is nonspecific and the main advantage is an easy access to bioptic material from any suspicious lesions. Vulvar cytology could play an important role in a diagnostic algorithm considering benefits such as being a relatively painless method compared to biopsy, inexpensive and there is also the availability to sample material from large areas. The accuracy of vulvar cytology depends on the good quality of sampling. It is generally accepted that good sampling could be achieved either with scraping with a wood or metal spatula, cotton-wool swab dipped in saline or careful scraping with ascalpel blade. Materials and Methods: We analyzed all cytological samples (108 cases) of vulvar smears from our Department of Clinical Cytology in a 10-year period between 2003 and 2012 which also included biopsy or vulvectomy. Comparing cytological and histological diagnosis we determined the sensitivity, specificity and predictive values (PPV, NPV). Cytological diagnosis was divided as follows: benign, ASCUS/VIN1 and VIN2+ (VIN2+ includes: VIN2, VIN3, ASC–cannot exclude high grade or invasive lesion and invasive lesions). Results: The positive predictive value of cytology for VIN2+ was extremely high, 98%, while for ASCUS/VIN1 it was very low (10%). Sensitivity, specificity and NPV for ASCUS/VIN1 read as follows: 33%, 91% and 98%, and for VIN2+ lesions: 70%, 97% and 57%. Cytologicaly benign vulvar lesions had sensitivity of 90%, specificity 77%, PPV 59% and NPV 95%.  Conclusion: The sensitivity and specificity of vulvar cytology was satisfactory only for high grade lesions. Used correctly, vulvar cytology has considerable application for the gynecologist. Our findings support the use of cytology in the clinical management of vulvar lesions.

cytology ; sensitivity ; VIN ; vulva

nije evidentirano