Vaginal intraepithelial neoplasia and the pap smear

OBJECTIVE: To assess the sensitivity of the vaginal smear cytologic examina tion in detecting vaginal intraepithelial neoplasia (VAIN) ann to evaluate the cytologic findings of cases of VAIN. STUDY DESIGN: Cases with a histologic diagnosis of VAIN were identified fro m the Barnes-Jewish Hospital South and North Campus over a period of five a nd nine years, respectively. Only posthysterectomy patients with a tissue b iopsy diagnosis of VAIN and with a vaginal smear obtained within? three mon ths of the biopsy were included in the study. Pertinent clinical informatio n was obtained by reviewing the medical records. Two pathologists reviewed the pathologic samples. RESULTS: Thirty-five vaginal smears from 31 posthysterectomy patients were included in the study. The mean age tons 57 years (range, 29-84). The cytol ogic diagnoses of smears from patients with VAIN included: high grade squam ous intraepithelial lesion (19 cases), low grade squamous intraepithelial l esion (10 cases), atypical squamous cells of uncertain significance (5 case s) and negative for malignancy (1 case). CONCLUSION: The sensitivity Of the vaginal smear cytologic examination in d etecting VAIN is 83%. Obscuring inflammation contributed to false negative diagnoses in two cases.