Correlation between colposcopically directed biopsy and large loop excision of the transformation zone and influence of age on the outcome.

OBJECTIVES: To assess the accuracy and correlation between Colposcopically Directed Biopsy (CDB) and Large Loop Excision of the Transformation Zone (LLETZ) and the influence of age. MATERIAL AND METHOD: A comparative analysis was conducted from the 352 women referred to Rajavithi Hospital from January 1998 to December 2003, to compare between CDB and LLETZ. Correlation was assessed by the percentage of concordance (accuracy), Spearman's rank correlation coefficient (r) and Kappa statistics (K). A subgroup analysis was performed in women aged > or = 50 years to evaluate the influence of age on the correlation. RESULTS: A 66.2% concordance was found between CDB and LLETZ. The correlation and agreement between the two procedures were low (r = 0.32, p < 0.0001; K = 0.24, p < 0.0001). In women aged > or = 50 years, the accuracy was 60.7% and stronger correlation and agreement were noted (r = 0.50, p < 0.0001; K = 0.31, p = 0.001). CONCLUSION: CDB is an inadequate diagnosis tool for Squamous Intraepithelial Lesion (SIL) in woman below 50 years of age. In women aged 50 years or more with satisfactory colposcopy, the accuracy and correlation between two procedures are not compromised.

Vulvar melanoma at the M. D. Anderson Cancer Center: 25 years later.

The purpose of this study was to review the clinical course of patients diagnosed with vulvar melanoma. Charts of patients diagnosed between 1970 and 1997 were reviewed for demographics, lesion characteristics, disease duration and extent, and treatments. Actuarial survival curves were computed by the Kaplan Meier method and compared by Cox proportional hazards regressions. Fifty-one patients (median age 54) with vulvar melanoma presented with a vulvar mass (39%), pain (30%), bleeding (24%), and itching (20%). Anatomical distribution was mucosa of the vulva (65%), vulvar epidermal site (21%), or unspecified vulva (14%), with 20% having multifocal disease at diagnosis. Histologic types were superficial spreading or nodular (50% each). Median lesion characteristics were diameter 2 cm, Breslow index 4.4 mm, and Clark level IV. Distribution of patients per American Joint Committee on Cancer (AJCC) stage was 29%, 50%, 16%, and 7% for stages I, II, III and IV, respectively. Inguinal node metastases were unilateral in 16% and bilateral in 7%. Despite complete surgical resection, 32 patients (63%) recurred. Median survival for all patients was 41 months (range, 5-324), with 91% 5-year survival for patients with stage I and 31% for stage >or= IIA (P = 0.0002). As with cutaneous melanoma, the AJCC classification, Breslow's thickness, and Clark's levels are the major predictors of overall survival (P = 0.0001 each) and disease-free survival (P