Analysis of influencing factors in diagnosis of stump vaginal lesions
10.3969/j.issn.1672-8467.2025.05.003
- VernacularTitle:全子宫切除术后残端阴道病变诊断的影响因素分析
- Author:
Ting XU
1
;
Yu QIAN
;
Zhi-ling ZHU
;
Yun WANG
;
Ming-zhi ZHAO
Author Information
1. 复旦大学附属妇产科医院妇科 上海 200090
- Publication Type:Journal Article
- Keywords:
vaginal carcinoma;
clinical characterization;
colposcopy;
vaginal resection;
influencing factors
- From:
Fudan University Journal of Medical Sciences
2025;52(5):639-646
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore influencing factors in diagnosing stump vaginal lesions by comparing the clinical data of patients with vaginal wall resection after total hysterectomy.Methods This retrospective study included patients who underwent vaginectomy due to stump vaginal lesions[including high-grade intraepithelial lesion(HSIL)or cancer]in Obstetrics and Gynecology Hospital,Fudan University between Jan 1,2013 and Sep 30,2022.The diagnosis was confirmed based on pathology results after vaginal stump resection,then patients were categorized into HSIL group and vaginal cancer(VC)group.We analyzed the differences in clinical features between the groups and evaluated the diagnostic value of various indicators for vaginal cancer.Additionally,within the VC group,patients whose colposcopic biopsy showed HSIL while whose pathology upgraded to invasive cancer after stump colpotomy were classified as the high-grade pathologic invasive cancer group(HC group).We then compared the HSIL group and the HC group to assess the predictive value of each index for pathological escalation.Results Significant differences were observed between the HSIL and VC groups in terms of age,etiology of previous hysterectomy,proportion of clinical symptoms,proportion of abnormal physical examination findings,proportion of abnormal imaging findings,proportion of papillary lesions,proportion of vaginal roof lesions,and squamous cell carcinoma antigen(SCCA)(P<0.05).However,there were no significant differences in fertility,previous hysterectomy,or HPV infection rate.Abnormal physical examination and imaging findings demonstrated better diagnostic performance(AUC>0.7).The proportion of vaginal apex lesions was significantly higher in the HC group compared with the HSIL group(P<0.05).Conclusion Previous hysterectomy for cervical cancer,presence of clinical symptoms,abnormal physical findings,abnormal imaging manifestations,and lesions at the vaginal apex are significant influencing factors in the diagnosis of vaginal stump carcinoma.Although colposcopy remains the primary diagnostic method,vaginal resection should be considered to rule out invasive carcinoma when high-risk factors exist,even if colposcopic biopsy pathology suggests HSIL.
