OBJECTIVETo review the diagnosis methods and treatment modalities of vulvar intraepithelial neoplasia III (VINIII) and to analyse its prognostic factors.

METHODSThe data of 24 patients with VINIII from 1992 to 2002 were retrospectively reviewed and analysed.

RESULTSAmong these 24 patients, 62.5% (15 patients) were aged less than 40 years and 37.5% (9 patients) over 40 years. Human papillomavirus (HPV) infection was found in 53.3% and 2/9 of these two groups. Treatment modality for all patients was surgical excision including extended local excision (33.3%) and simple vulvectomy (66.7%). 3 patients (12.5%) developed recurrence. Positive resection margin was correlated with recurrence, while age, HPV infection, multifocality and resection modality were not.

CONCLUSIONDuring recent years, the incidence of VIN has been on the increase in younger woman patients which maybe due to the increase of HPV infection, and the data show that the recurrence rate is correlated with positive margin. Treatment should be individualized and either extended local excision or simple vulvectomy is appropriate. Periodical follow-up should be done.

Adult ; Aged ; Carcinoma in Situ ; diagnosis ; surgery ; virology ; China ; epidemiology ; Female ; Humans ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasms, Squamous Cell ; diagnosis ; surgery ; virology ; Papillomaviridae ; Papillomavirus Infections ; epidemiology ; Prognosis ; Retrospective Studies ; Vulvar Neoplasms ; diagnosis ; surgery ; virology

OBJECTIVE: To determine, by means of long-term follow-up evaluation, the outcome and accuracy of stereotactic core-needle biopsy (SCNB) of non-mass calcifications observed at mammography, and to analyze the factors contributing to false-negative findings. MATERIALS AND METHODS: Using a 14-gauge needle, SCNB was performed in cases involving 271 non-mass calcified lesions observed at mammography in 267 patients aged 23 72 (mean, 47) years. We compared the SCNB results with those of long-term follow-up which included surgery, mammography performed for at least six months, and reference to Korean Cancer Registry listings. We investigated the retrieval rate for calcifications observed at specimen mammography and histologic evaluation, and determined the incidence rate of cancer, sensitivity, and the underestimation rate for SCNB. False-negative cases were evaluated in terms of their mammographic findings, the effect of the operators' experience, and the retrieval rate for calcifications. RESULTS: For specimen mammography and histologic evaluation of SCNB, the retrieval rate for calcifications was, respectively, 84% and 77%. At SCNB, 54 of 271 lesions (19.9%) were malignant [carcinoma in situ, 45/54 (83%) ], 16 were borderline, and 201 were benign. SCNB showed that the incidence of cancer was 5.0% (6/120) in the benign mammographic category and 31.8% (48/151) in the malignant category. The findings revealed by immediate surgery and by longterm follow-up showed, respectively, that the sensitivity of SCNB was 90% and 82%. For borderline lesions, the underestimation rate was 10%. For false-negative cases, which were more frequent among the first ten cases we studied (p = 0.01), the most frequent mammographic finding was clustered amorphous calcifications. For true-negative and false-negative cases, the retrieval rate for calcifications was similar at specimen mammography (83% and 67%, respectively; p = 0.14) and histologic evaluation (79% and 75%, respectively; p = 0.47). CONCLUSION: In this study group, most diagnosed cancers were in-situ lesions, and long-term follow-up showed that the sensitivity of SCNB was 82%. Falsenegative findings were frequent during the operators' learning period.
Adult ; Aged ; Biopsy, Needle/*methods/standards/statistics & numerical data ; Breast/*pathology/surgery ; Breast Neoplasms/*diagnosis/epidemiology/surgery ; Calcinosis/*diagnosis/epidemiology/surgery ; Carcinoma in Situ/*diagnosis/epidemiology/surgery ; Diagnosis, Differential ; Disease Progression ; False Negative Reactions ; Female ; Follow-Up Studies ; Human ; Incidence ; Mammography/statistics & numerical data ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Time Factors ; Treatment Outcome