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Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1)

Received: 3 January 2022    Accepted: 24 January 2022    Published: 5 February 2022
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Abstract

Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of the specificity and localization of the lesion relative to the vulvar ring. This paper evaluated the sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index in detecting vulvar dermatosis compared with histopathology as a reference test. Structured ISSVD vulvodynia pattern questionnaire and TRIV form data were utilized for the study. The data obtained were analyzed using StatSoft (Dell, Austin, Texas), Statistica 12 (TIBCO®, Palo Alto, CA), and SPSS 20 (IBM, Armonk, NY). Ethical approval for the study was obtained from the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. The histopathological diagnosis of vulvar dermatosis was confirmed in 72 patients at first biopsy. Lesions specific for vulvar dermatosis were visible by TRIV in 82 patients. The resulting difference of ten patients were participants with early vulvar dermatosis. In six of them, vulvar dermatosis was confirmed at a later biopsy during the study period. There was no statistically significant difference between the scores of points (median and range), frequency and relative frequency of vulvar findings within one item of the vulvoscopy index and histopathology, except for ten patients with early forms of vulvar dermatoses. The sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index for detecting vulvar dermatosis were 100%, 96.1%, and 96.9%, respectively. The positive and negative predictive values were 0.88 and 1.00, respectively. The vulvoscopy index represents a compelling clinical test for detecting vulvar dermatoses. Differences between vulvoscopic and histopathological diagnostics implicate the impossibility of histopathology in recognizing early forms of vulvar dermatoses. Accordingly, early dermatoses could represent a key area for applying this test. ClinicalTrials.gov Identifier: NCT02732145.

Published in Journal of Gynecology and Obstetrics (Volume 10, Issue 1)
DOI 10.11648/j.jgo.20221001.16
Page(s) 39-47
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Vulvar Dermatosis, Vulvoscopy, Three Vulvar Rings, Three Rings Vulvoscopy, Vulvoscopy Index

References
[1] Micheletti L, Preti M, La Monica F. La vulvoscopia, no debe ser destinada como el examen colposcopico de la vulva. [Vulvoscopy should not be intended as colposcopic examination of the vulva.] AMATGI 2011; 4: 29-34.
[2] McLean JM. Embryology and congenital anomalies of the vulval area. Chapter in Ridley CM. The Vulva. Edinburgh London Melbourne and New York, Churchill Livingstone; 1988: 1-38 and in Ridley CM, Neill SM. The Vulva. 2nd edition. Blackwell Science Ltd; 1999: 1-36.
[3] McLean JM. Anatomy and physiology of the vulval area. Chapter in Ridley CM. The Vulva. Churchill Livingstone, Edinburgh London Melbourne and New York 1988; pp 39-65 and in Ridley CM, Neill SM. The Vulva. 2nd edition. Blackwell Science Ltd 1999; pp 37-63.
[4] Neill SM, Lewis FM. Basics of vulval embryology, anatomy and physiology. Chapter in Neill SM, Lewis FM. The Vulva. 3rd edition. Blackwell Publishing 2009; 1-33.
[5] Baggish MS. Colposcopy of the cervix, vagina, and vulva: a comprehensive textbook. 1st ed. Mosby, Elsevier; 2003.
[6] Kesic V. Colposcopy of the vulva, perineum and anal canal. Chapter in Bosze P, Luesley DM. EACG Course Book on Colposcopy. Budapest, Primed-X-Press; 2003.
[7] Byrne MA, Walker MM, Leonard J, Pryce D, Taylor-Robinson D. Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy. Genitourin Med 1989; 65: 46-9.
[8] Bornstein J, Sideri M, Tatti S, Walker P, Prendiwille W, Haefner HK. 2011 Terminology of the Vulva of the International Federation for Cervical Pathology and Colposcopy. J Lower Genit Tract Dis 2012; 16: 290-5.
[9] Foster DC, Stockdale CK, Simpson R, Kirtshhig G. Core Outcome Sets for Clinical Trials and Observational Studies in Vulvovaginal Disease. J Lower Genit Tract Dis 2017; 21: 163-5.
[10] Harni V, Babic D, Barisic D. "Three Rings Vulvoscopy" – A New Approach to the Vulva. Gynaecol Perinatol 2015; 24: 37-45.
[11] Harni V, Babic D, Barisic D. "Three Rings Vulvoscopy" – A New Approach to the Vulva. Chapter in Watson L (ed.) Cryosurgery and Colposcopy: Practices, Outcomes, and Potential Complications. New York, Nova Science Publishers Inc; 2016. ISBN: 978-1-63484-507-6.
[12] van Beurden M, van der Vange N, de Craen AJM, Tjong-A-Hung SP, ten Kate FJW, ter Schegget J, et al. Normal findings in vulvar examination and vulvoscopy. J Br Obstet Gynaecol 1997; 104: 320-4.
[13] Audisio T, Zarazaga J, Vainer O. A Classification of Vulvoscopic Findings for Clinical Diagnosis. J Lower Genit Tract Dis 1999; 3: 7-18.
[14] Chren MM. Giving "scale" new meaning in dermatology: measurement matters. Arch Dermatol 2000; 136: 788-90.
[15] Simpson RC, Murphy R. Considerations for Disease Impact and Outcome Measures in Vulvar Disease. J Lower Genit Tract Dis 2012; 16: 460-3.
[16] ISSVD Vulvodynia Pattern Questionnaire. Available at: https://netforum.avectra.com/temp/ClientImages/ISSVD/3ef9c6ea-aac7-4d2b-a37f-058ef9f11a67.pdf Last accessed May 23, 2015.
[17] Haefner H, Collins M, Davis GD, Edwards L, Foster D, Hartmann E, et al. The Vulvodynia Guideline. J Lower Genit Tract Dis 2005; 9: 40-51.
[18] Stockdale CK, Lawson HW. 2013 Vulvodynia Guideline Update. J Lower Genit Tract Dis 2014; 18: 93-100.
[19] Bornstein J, Goldstein AT, Stockdale CK, Bergeron S, Pukall C, Zolnoun D, et al. 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. J Lower Genit Tract Dis 2016; 20: 126-30.
[20] National Institute on Aging, National Institute of Health, U.S. Department of Health and Human Services. Why Population Aging Matters. A Global Perspective. Publication No. 07-6134. 2007.
[21] Surveillance, Epidemiology, and End Results. SEER Cancer Stat Facts: Vulvar Cancer. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/statfacts/html/vulva.html.
[22] Moyal-Barracco M, Wendling J. Vulvar dermatosis. Best Pract Res Clin Obstet Gynaecol 2014; 28: 946-58.
[23] Doyen J, Demoulin S, Delbecque K, Goffin F, Kridelka F, and Delvenne P. Vulvar Skin Disorders throughout Lifetime: About Some Representative Dermatoses. BioMed Research International Volume 2014, Article ID 595286. DOI: http://dx.doi.org/10.1155/2014/595286.
[24] van der Linden M, Meeuwis KA, Bulten J, Bosse T, van Poelgeest MI, de Hullu JA. Paget disease of the vulva. Crit Rev Oncol Hematol. 2016; 101: 60-74. DOI: 10.1016/j.critrevonc.2016.03.008.
[25] van der Zwan JM, Siesling S, Blokx WA, Pierie JPEN and Capocaccia R. Invasive extramammary Paget's disease and the risk of secondary tumours in Europe. EJSO, 2012; 38: 214-221.
[26] Fruchter R, Melnick L, Pomeranz MK. Lichenoid vulvar disease: A review. Int J Womens Dermatol 2017; 3: 58-64.
[27] Halonen P. Liche sclerosus and lichen planus in women. Incidence, risk of cancer and causes of death. Academic Dissertation, University of Helsinki, Helsinki 2020.
[28] United Nations Population Fund (UNFPA), HelpAge International. Ageing in the Twenty-First Century: A Celebration and A Challenge. New York, London, 2012. ISBN 978-0-89714-981-5.
[29] Bleeker MCG, Visser PJ, Overbeek LIH, van Beurden M, Berkhof J. Lichen Sclerosus: Incidence and Risk of Vulvar Squamous Cell Carcinoma. Cancer Epidemiol Biomarkers Prev 2016; 25: 1224-30.
[30] Schuurman MS, van den Einden LC, Massuger LF, Kiemeney LA, van der Aa MA, de Hullu JA. Trends in incidence and survival of Dutch women with vulvar squamous cell carcinoma. Eur J Cancer 2013; 49: 3872-80.
[31] Andrews JC, Bogliatto F, Lawson HW, Bornstein J. Speaking the Same Language: Using Standardized Terminology. J Lower Genit Tract Dis 2016; 20: 8-10.
[32] Simundic AM. Measures of Diagnostic Accuracy: Basic Definitions. Med Biol Sci 2008: 22.
[33] Regauer S, Liegl B, Reich O. Early vulvar lichen sclerosus: a histopathological challenge. Histopathology 2005; 47: 340-7.
Cite This Article
  • APA Style

    Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. (2022). Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1). Journal of Gynecology and Obstetrics, 10(1), 39-47. https://doi.org/10.11648/j.jgo.20221001.16

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    ACS Style

    Vesna Harni; Damir Babic; Suzana Ljubojevic-Hadzavdic; Dubravko Barisic. Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1). J. Gynecol. Obstet. 2022, 10(1), 39-47. doi: 10.11648/j.jgo.20221001.16

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    AMA Style

    Vesna Harni, Damir Babic, Suzana Ljubojevic-Hadzavdic, Dubravko Barisic. Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1). J Gynecol Obstet. 2022;10(1):39-47. doi: 10.11648/j.jgo.20221001.16

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  • @article{10.11648/j.jgo.20221001.16,
      author = {Vesna Harni and Damir Babic and Suzana Ljubojevic-Hadzavdic and Dubravko Barisic},
      title = {Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1)},
      journal = {Journal of Gynecology and Obstetrics},
      volume = {10},
      number = {1},
      pages = {39-47},
      doi = {10.11648/j.jgo.20221001.16},
      url = {https://doi.org/10.11648/j.jgo.20221001.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20221001.16},
      abstract = {Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of the specificity and localization of the lesion relative to the vulvar ring. This paper evaluated the sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index in detecting vulvar dermatosis compared with histopathology as a reference test. Structured ISSVD vulvodynia pattern questionnaire and TRIV form data were utilized for the study. The data obtained were analyzed using StatSoft (Dell, Austin, Texas), Statistica 12 (TIBCO®, Palo Alto, CA), and SPSS 20 (IBM, Armonk, NY). Ethical approval for the study was obtained from the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. The histopathological diagnosis of vulvar dermatosis was confirmed in 72 patients at first biopsy. Lesions specific for vulvar dermatosis were visible by TRIV in 82 patients. The resulting difference of ten patients were participants with early vulvar dermatosis. In six of them, vulvar dermatosis was confirmed at a later biopsy during the study period. There was no statistically significant difference between the scores of points (median and range), frequency and relative frequency of vulvar findings within one item of the vulvoscopy index and histopathology, except for ten patients with early forms of vulvar dermatoses. The sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index for detecting vulvar dermatosis were 100%, 96.1%, and 96.9%, respectively. The positive and negative predictive values were 0.88 and 1.00, respectively. The vulvoscopy index represents a compelling clinical test for detecting vulvar dermatoses. Differences between vulvoscopic and histopathological diagnostics implicate the impossibility of histopathology in recognizing early forms of vulvar dermatoses. Accordingly, early dermatoses could represent a key area for applying this test. ClinicalTrials.gov Identifier: NCT02732145.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Diagnostic Accuracy of the Vulvoscopy Index for Detection of Vulvar Dermatosis (DATRIV Study, Part 1)
    AU  - Vesna Harni
    AU  - Damir Babic
    AU  - Suzana Ljubojevic-Hadzavdic
    AU  - Dubravko Barisic
    Y1  - 2022/02/05
    PY  - 2022
    N1  - https://doi.org/10.11648/j.jgo.20221001.16
    DO  - 10.11648/j.jgo.20221001.16
    T2  - Journal of Gynecology and Obstetrics
    JF  - Journal of Gynecology and Obstetrics
    JO  - Journal of Gynecology and Obstetrics
    SP  - 39
    EP  - 47
    PB  - Science Publishing Group
    SN  - 2376-7820
    UR  - https://doi.org/10.11648/j.jgo.20221001.16
    AB  - Three rings vulvoscopy (TRIV) has previously been described to facilitate the diagnosis and treatment of vulvar discomfort. The distinction between outer, middle, and inner vulvar rings is based on differences in anatomy, histology, and embryology. The vulvoscopy index was designed considering the patient's history, clinical exam, and assessment of the specificity and localization of the lesion relative to the vulvar ring. This paper evaluated the sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index in detecting vulvar dermatosis compared with histopathology as a reference test. Structured ISSVD vulvodynia pattern questionnaire and TRIV form data were utilized for the study. The data obtained were analyzed using StatSoft (Dell, Austin, Texas), Statistica 12 (TIBCO®, Palo Alto, CA), and SPSS 20 (IBM, Armonk, NY). Ethical approval for the study was obtained from the Institutional Review Board of Polyclinic Harni, and all patients provided written informed consent. The histopathological diagnosis of vulvar dermatosis was confirmed in 72 patients at first biopsy. Lesions specific for vulvar dermatosis were visible by TRIV in 82 patients. The resulting difference of ten patients were participants with early vulvar dermatosis. In six of them, vulvar dermatosis was confirmed at a later biopsy during the study period. There was no statistically significant difference between the scores of points (median and range), frequency and relative frequency of vulvar findings within one item of the vulvoscopy index and histopathology, except for ten patients with early forms of vulvar dermatoses. The sensitivity, specificity, and diagnostic accuracy of the vulvoscopy index for detecting vulvar dermatosis were 100%, 96.1%, and 96.9%, respectively. The positive and negative predictive values were 0.88 and 1.00, respectively. The vulvoscopy index represents a compelling clinical test for detecting vulvar dermatoses. Differences between vulvoscopic and histopathological diagnostics implicate the impossibility of histopathology in recognizing early forms of vulvar dermatoses. Accordingly, early dermatoses could represent a key area for applying this test. ClinicalTrials.gov Identifier: NCT02732145.
    VL  - 10
    IS  - 1
    ER  - 

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Author Information
  • Department of Obstetrics and Gynaecology, Polyclinic Harni, Zagreb, Croatia

  • Department of Pathology and Cytology, University Hospital Center, Zagreb, Croatia

  • Department of Dermatovenereology, University Hospital Center, Zagreb, Croatia

  • Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg Klinikum GmbH, Schwarzach im Pongau, Austria

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