| Objective: Improve the understanding of VAIN through analysing the pathogenic pattern.At the same time,the clinical efficacy of imiquimod ointment in the treatment of VAIN was explored to provide the basis for standardizing the diagnosis and individualized treatment of VAIN.Methods:1.The data of total 1368 patients was collected from the First Affiliated Hospital of Xiamen University from November 2018 to December 2020.All the patients received biopsy under colposcopy location by the same physician.Ruled out those with inflammation and no atypical epithelium or carcinoma in vaginal or cervical pathology,243 cases were diagnosed as VAIN by pathology,including 199 cases(81.89%)of Low Grade Vaginal Intraepithelial Neoplasia(LG-VAIN)and 44 cases(18.11%)of High Grade Vaginal Intraepithelial Neoplasia(HG-VAIN).Among them,there were 80 patients with a history of hysterectomy,163 patients without a history of hysterectomy(133 cases of VAIN complicated with cervical intraepithelial neoplasia(CIN)).And there were 774 cases of CIN alone.The pathogenic pattern of VAIN was retrospectively analyzed and relevant statistics were conducted.P < 0.05 was considered statistically significant.2.At the same time,the short-term clinical efficacy of 21 patients with VAIN who received imiquimod ointment monotherapy during this period was analyzed.Results:1.pathogenic pattern:(1)Distribution of lesions: 32 cases(13.17%)were isolated lesions and 211 cases(86.83%)were multiple lesions;There were 151 cases(62.14%)in the upper vagina,22 cases(9.05%)in the lower vagina,and 70 cases(28.81%)in both upper and lower vagina.(2)Age characteristic: The age of 243 patients ranged from23 to 70 years old,and the median age was 46(35,53)years old.The median age of 44HG-VAIN patients was 47(35,54)years old,and the median age of 199 LG-VAIN patients was 46(36,53)years old,and there was no statistical significance(P>0.05);In the the group without hysterectomy,The median age of 133 patients with CIN complicated with VAIN was 49(37,55)years old,and the median age of 774 patients with CIN alone was 42(32,47)years old,Difference was statistically significant between them(P<0.05).(3)Liquid based cytology data was found in 224 of the 243 VAIN patients,including 186 LG-VAIN patients,of which 45 cases were negative for intraepithelial lesion or malignancy(NILM)(24.19%),133 cases were atypical squamous cell of undetermined significance(ASC-US)and low-grade squamous intraepithelial lesion(LSIL)(71.51%),8 cases of atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)and high-grade squamous intraepithelial lesion(HSIL)(4.30%),and 38 cases of HG-VAIN(10.53%),of which 6cases were NILM(15.79%),28 cases were ASC-US and LSIL(73.68%),4 cases were ASC-H and HSIL(10.53%).There was no correlation between the level of VAIN and the degree of cytological abnormality(P >0.05).(4)VAIN and High-risk Human papillomavirus(HR-HPV)infection:Among 243 patients with VAIN,238 patients had HPV data.184 cases were positive for HR-HPV with a total rate of 77.31%.the positive rate of HR-HPV in HG-VAIN and LG-VAIN were 74.36% and 90.70%,respectively,the difference was statistically significant(P<0.05);There was no significant difference in the proportion of single and multiple HR-HPV infection between HG-VAIN and LG-VAIN(P>0.05);There were significant differences in the proportion of single and multiple HR-HPV infections between CIN complicated with VAIN and CIN alone(P<0.05);The top 4 HR-HPV types in HG-VAIN were HPV 16(38.71%),HPV52(19.35%),HPV51(16.12%),and HPV39(12.90%).The top 4 HR-HPV types in LG-VAIN were HPV52(28.6%),HPV16(15.18%),HPV53(15.18%),and HPV81(13.39%).(5)In the patients with VAIN after hysterectomy,the main reasons for previous hysterectomy were cervical cancer and CIN.(6)In patients with CIN complicated with VAIN without hysterectomy,there was no significant correlation between the grade of VAIN and CIN(P>0.05).2.The short-term efficacy of imiquimod ointment in the treatment of 21 cases of VAIN:8 cases were cured,10 cases were improved,the total effective rate was 85.71%,the cure rate was 38.10%,10 cases of HPV turned negative,the total clearance rate was47.62%.Adverse reactions of different degrees occurred in 7 patients,and the incidence was 33.33%.All patients could tolerate the adverse reactions,and they get minor as the times of medication increases.Conclusion:(1)Most of the lesions in VAIN were multifocal,and most of the lesions were located in the upper vagina and fornix.Attention should be paid to these sites during colposcopy and multi-point biopsy should be taken.Although the grade of VAIN was not relevant with age,older patients were more likely to have CIN complicated with VAIN in patients without hysterectomy;There was no significant correlation between the lesion level of VAIN and the abnormal degree of cytological results,suggesting that VAIN could not be screened by liquid based cytology alone.The total HR-HPV infection rate in VAIN patients was 77.31%,suggesting that HPV infection was the main cause of VAIN.The infection rate of HG-VAIN was higher than that of LG-VAIN,and there were differences in the common types of HPV between them.Single or multiple HPV could not indicate the severity of the lesion,and multiple HPV patients were more likely to have cervical and vaginal lesions at the same time.Patients underwent hysterectomy for HPV-related cervical lesions are more likely to have VAIN,suggesting that HPV infection can infect cervix and vagina simultaneously.The lesion of cervix and vagina can occur at the same time or at different time.(2)The recent efficacy analysis of imiquimod ointment in the treatment of VAIN showed good outcome,and the adverse reaction rate was low and controllable.The patient compliance was good,and the long-term efficacy remains to be further observed. |
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