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EP1192 Surgical treatment of the vulva in the absence of a conclusive diagnosis of squamous cell carcinoma, data from a 10 year cohort
  1. LW Jonker1,
  2. LW Jonker2,
  3. S Dasgupta,
  4. PC Ewing-Graham2 and
  5. HC van Doorn1
  1. 1Department of Gynaecologic Oncology
  2. 2Department of Pathology, ErasmusMC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands


Introduction/Background Treatment decision in a vulvar lesion is guided by the histopathological diagnosis of the lesional biopsy. For vulvar intraepithelial neoplasia (VIN), a local excision can be performed, whereas for vulvar squamous cell carcinoma (SCC), more radical procedures are mandatory. In certain cases, despite the lack of a conclusive biopsy diagnosis of SCC, the surgeon opts for a radical treatment, to avoid repeated surgery. This exploratory retrospective study was conducted on a cohort of patients who underwent vulvar excision, in the absence of a conclusive biopsy diagnosis of SCC. We aimed to identify the predictive factors for the presence of a SCC, and describe the treatment chosen.

Methodology All patients who underwent vulvar excisions (2005–2016) at Erasmus MC, without a definitive diagnosis of vulvar SCC on the preoperative biopsy were included. Patient characteristics and treatment details were retrieved. The surgical treatment was categorized as definitive, under- or over-treatment, based on the histopathology of the excision specimen. Logistic regression analysis was performed. Approval was obtained of the Erasmus MC Ethical Board.

Results Of 1245 patients who underwent vulvar excisions, 113 met the inclusion criteria. In 57% (64/113), SCC was diagnosed in the excision specimen. [Figure 1] A higher age (p=0.03), and a suspicion of SCC on pre-operative biopsy (p<0.01) were found to be predictive of a final diagnosis of SCC on univariate analysis. On multivariable analysis, suspicion of SCC on biopsy was the only predictor (p<0.01); with a positive predictive value of 82%. The surgical procedure was definitive for 72%, under-treatment for 25%, and over-treatment for 3%.

Conclusion Suspicion of SCC on biopsy is strongly predictive of a final diagnosis of carcinoma. In these cases more radical (definitive) treatment can be chosen to avoid second surgical procedures, at the cost of minimal overtreatment.

Disclosure Nothing to disclose

Abstract EP1192 Table 1

Characteristics of the patients with and without SCC at final pathology

Abstract EP1192 Figure 1

Distribution of patients according to their pre-operative biopsy findings, and treatments received

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