Interobserver Agreement Across Subspecialties for Diagnosis of Differentiated Vulvar Intraepithelial Neoplasia and Predictive Values of 20 Histologic Features.

Authors

Shula A Schechter
May P Chan
Selvaraj Muthusamy
Stephanie L Skala
Grace Y. Wang, Beaumont Health

Document Type

Article

Publication Date

12-1-2023

Publication Title

Archives of pathology & laboratory medicine

Abstract

CONTEXT.—: Differentiated vulvar intraepithelial neoplasia (dVIN) is a human papillomavirus-independent lesion with the potential for rapid progression to invasive squamous cell carcinoma (SCC). The histopathologic features of dVIN are diverse, have overlapping characteristics with lichen sclerosus (LS) and lichen simplex chronicus (LSC), and may be diagnosed by dermatopathologists or gynecologic pathologists because of the vulva's anatomic location.

OBJECTIVES.—: To identify the salient histopathologic features of dVIN, particularly those that predict progression to SCC, and to evaluate interobserver agreement in diagnosing dVIN within the same subspecialty and across subspecialties.

DESIGN.—: One general surgical pathologist, 2 pathology-trained dermatopathologists, and 1 gynecologic pathologist blinded to the final diagnoses were asked to record 20 histopathologic features and to provide their final interpretations on cases of dVIN (n = 65), LS (n = 126), LSC (n = 112), and LS with LSC (n = 6).

RESULTS.—: Interobserver agreement for the 4 diagnoses and 10 histopathologic features was moderate. Logistic regression analysis indicated that keratin pearls, basal pleomorphism, and basal layer disarray were independent variables for diagnosing dVIN (coefficients 1.95, 1.97, and 0.91, respectively; P < .001) and progression to SCC (coefficients 1.96, 1.20, and 1.08, respectively; P < .001).

CONCLUSIONS.—: There is no single histopathologic feature pathognomonic for dVIN; however, the presence of keratin pearls, basal pleomorphism, and basal layer disarray should raise high suspicion for dVIN and concurrent SCC. Expertise in both dermatologic and gynecologic pathology is beneficial for diagnosing dVIN.

Volume

147

Issue

12

First Page

1431

Last Page

1437

Recommended Citation

Schechter SA, Chan MP, Muthusamy S, Skala SL, Wang GY. Interobserveragreement across subspecialties for diagnosis of differentiated vulvar intraepithelial neoplasia and predictive values of 20 histologic features. Arch Pathol Lab Med. 2023 Dec 1;147(12):1431-1437. doi: 10.5858/arpa.2022-0088-OA. PMID: 36821250.

DOI

10.5858/arpa.2022-0088-OA

ISSN

1543-2165

PubMed ID

36821250