Clinical characteristics and risk factors to high-grade vaginal intraepithelial neoplasia: a single-institution study.

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.