The role of cytology in the detection of preinvasive and invasive vulvar changes depending of the sampling method

Aim: Exfoliative cytology of vulvar samples is used in diagnostics and follow up of vulvar changes, especially those in which biopsy is not indicated. Traditionally, samples were taken by spatula and the cellularity of the samples was low. To improve cellularity, taking samples by endocervical brush was introduced. Material and methods: In the retrospective study 1866 vulvar samples taken in the period from July 1, 2011 to December 31, 2013 were analyzed. Cellularity of the samples, as well as the atypical squamous cells (ASC) to squamous intraepithelial lesion or carcinoma (SIL+) ratio, and the cytohistologic correlation were analyzed. Results: In the vulvar disease specialized unit most samples were taken by endocervical brush, and the less unsatisfactory because of scantness samples (3.4%), as well as the satisfactory but scant samples (5.6%) were detected; the highest proportion of scant samples was detected in the outpatient gynaecology services(13.7% and 25.3%) where samples were taken traditionally by spatula. ASC:SIL+ ratio within fully satisfactory samples was the lowest in the other oncologic units(1.9:1), in the vulvar disease unit it was 2.6:1, in other clinic units it was 3.5:1, while in the outpatient gynaecology services it was 2.3:1. In the group of satisfactory but scant samples the ratio ASC:SIL+ was ranging from 5: 1 to 11:0 depending of the infirmary in which the samples were taken. Cytohistologic correlation in 159 cases was high in the detection of the preinvasive (94.1%) and invasive (100.0%) lesions, but with low specificity(35.4%). Conclusion: Vulvar samples taken by endocervical brush are significantly more cellular than the spatula taken samples, and cytologic interpretation of these samples is more adequate with lower ASC:SIL ratio. Cytologic vulvar samples cannot replace biopsy, but can be helpful in the patients with indistinctive lesions, or in controlling patients with confirmed disease.