{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T12:59:30Z","timestamp":1794315570162,"version":"4.9.0"},"reference-count":46,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T00:00:00Z","timestamp":1695081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft"},{"name":"Friedrich-Alexander-Universit"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>(1) Background: Vaginal intraepithelial neoplasia (VaIN) is a rare premalignant disease caused by persistent human papillomavirus (HPV) infection. Diagnosing VaIN is challenging; abnormal cytology and positive HPV tests are usually the first signs, but published data on their accuracy for detecting it are rare and contradictory. The aim of this study is to compare the results of hrHPV and cytology co-testing with the histological findings of the vagina. (2) Methods: In the certified Dysplasia Unit at Erlangen University Hospital, cytology and HPV samples from the uterine cervix or vaginal wall after hysterectomy were obtained between 2015 and 2023 and correlated with histological findings in biopsies from the vaginal wall. Women without vaginal biopsy findings or concomitant cervical disease were excluded. (3) Results: In all, 279 colposcopies in 209 women were included. The histological results were: benign (n = 86), VaIN I\/vLSIL (n = 116), VaIN II\/vHSIL (n = 41), VaIN III\/vHSIL (n = 33), and carcinoma (n = 3). Accuracy for detecting VaIN was higher in women with previous hysterectomies. Positive HPV testing during colposcopy increased the likelihood for VaIN II\/III\/vHSIL threefold. The detection rate for VaIN III\/vHSIL was 50% after hysterectomy and 36.4% without hysterectomy. (4) Conclusions: Women with risk factors for VaIN, including HPV-16 infection or prior HPV-related disease, need careful work-up of the entire vaginal wall. Hysterectomy for HPV-related disease and a history of cervical intraepithelial neoplasia (CIN) also increased the risk for VaIN II\/III\/vHSIL.<\/jats:p>","DOI":"10.3390\/cancers15184633","type":"journal-article","created":{"date-parts":[[2023,9,19]],"date-time":"2023-09-19T23:17:20Z","timestamp":1695165440000},"page":"4633","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Cytology and HPV Co-Testing for Detection of Vaginal Intraepithelial Neoplasia: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0729-2064","authenticated-orcid":false,"given":"Frederik A.","family":"Stuebs","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K.","family":"Dietl","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin C.","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Hospital ANregiomed Ansbach, Escherichstrasse 1, 91522 Ansbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Adler","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Waldstrasse 6, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol Immanuel","family":"Geppert","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Krankenhausstrasse 8\u201310, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arndt","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Institute of Pathology, Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Krankenhausstrasse 8\u201310, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Kn\u00f6ll","sequence":"additional","affiliation":[{"name":"Institute of Clinical and Molecular Virology, Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Schlossgarten 4, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grit","family":"Mehlhorn","sequence":"additional","affiliation":[{"name":"Gynecology Consultancy Practice, German Cancer Society (DKG) and Committee on Cervical Pathology and Colposcopy (AG-CPC) Certified Gynecological Dysplasia Consultancy Practice, Frauenarztpraxis Erlangen, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias W.","family":"Beckmann","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1622-5250","authenticated-orcid":false,"given":"Carla E.","family":"Schulmeyer","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5484-2575","authenticated-orcid":false,"given":"Felix","family":"Heindl","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julius","family":"Emons","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Seibold","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika S.","family":"Behrens","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4239-5528","authenticated-orcid":false,"given":"Paul","family":"Gass","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen\u2013European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen University Hospital, Friedrich-Alexander-Universit\u00e4t Erlangen-N\u00fcrnberg, Universitaetsstrasse 21\u201323, 91054 Erlangen, 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Gynecol. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cong, Q., Song, Y., Wang, Q., Zhang, H., Gao, S., and Sui, L. (2018). A Retrospective Study of Cytology, High-Risk HPV, and Colposcopy Results of Vaginal Intraepithelial Neoplasia Patients. Biomed. Res. Int., 2018.","DOI":"10.1155\/2018\/5894801"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s00404-020-05441-5","article-title":"Accuracy of colposcopic findings in detecting vaginal intraepithelial neoplasia: A retrospective study","volume":"301","author":"Stuebs","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2827","DOI":"10.1002\/ijc.23446","article-title":"Risk factors for invasive squamous cell carcinoma of the vulva and vagina\u2014Population-based case-control study in Denmark","volume":"122","author":"Madsen","year":"2008","journal-title":"Int. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1006\/gyno.2001.6502","article-title":"A population-based study of squamous cell vaginal cancer: HPV and cofactors","volume":"84","author":"Daling","year":"2002","journal-title":"Gynecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.ygyno.2008.05.015","article-title":"Smoking increases the risk of high-grade vaginal intraepithelial neoplasia in women with oncogenic human papillomavirus","volume":"110","author":"Sherman","year":"2008","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1097\/01.AOG.0000435450.08980.de","article-title":"A clinicopathologic study of vaginal intraepithelial neoplasia","volume":"122","author":"Zeligs","year":"2013","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0002-9378(97)80018-X","article-title":"Vaginal intraepithelial neoplasia: Risk factors for persistence, recurrence, and invasion and its management","volume":"176","author":"Sillman","year":"1997","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_10","first-page":"818","article-title":"High-grade vaginal intraepithelial neoplasia and risk of progression to vaginal cancer: A multicentre study of the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV)","volume":"20","author":"Sopracordevole","year":"2016","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lamos, C., Mihaljevic, C., Aulmann, S., Bruckner, T., Domschke, C., Wallwiener, M., Paringer, C., Fluhr, H., Schott, S., and Dinkic, C. (2016). Detection of Human Papillomavirus Infection in Patients with Vaginal Intraepithelial Neoplasia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0167386"},{"key":"ref_12","unstructured":"WHO (2014). Classification of Tumours of Female Reproductive Organs, World Health Organization. [4th ed.]. Available online: https:\/\/publications.iarc.fr\/Book-And-Report-Series\/Who-Classification-Of-Tumours\/WHO-Classification-Of-Tumours-Of-Female-Reproductive-Organs-2014."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.5858\/arpa.LGT200570","article-title":"The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology","volume":"136","author":"Darragh","year":"2012","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00404-021-05986-z","article-title":"Human papilloma virus genotype distribution in women with premalignant or malignant lesions of the uterine cervix","volume":"304","author":"Stuebs","year":"2021","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/s11845-014-1231-z","article-title":"Clinical features, treatment and outcomes of vaginal intraepithelial neoplasia in a Chinese tertiary centre","volume":"185","author":"Chen","year":"2016","journal-title":"Ir. J. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1002\/(SICI)1097-0215(19970729)72:3<412::AID-IJC7>3.0.CO;2-S","article-title":"Distinct manifestations of human papillomaviruses in the vagina","volume":"72","author":"Sugase","year":"1997","journal-title":"Int. J. Cancer"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"410.e1","DOI":"10.1016\/j.ajog.2013.01.047","article-title":"A contemporary analysis of epidemiology and management of vaginal intraepithelial neoplasia","volume":"208","author":"Gunderson","year":"2013","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1097\/AOG.0b013e31819bd6e0","article-title":"Human papillomavirus type-distribution in vulvar and vaginal cancers and their associated precursors","volume":"113","author":"Smith","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/AOG.0b013e318254f90c","article-title":"2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy","volume":"120","author":"Bornstein","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1097\/LGT.0b013e3182800ee2","article-title":"Vaginal cancer: The experience from 2 large academic centers during a 15-year period","volume":"17","author":"Gunderson","year":"2013","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_21","first-page":"286","article-title":"Vulvar and Vaginal Cancer, Vulvar Intraepithelial Neoplasia 3 and Vaginal Intraepithelial Neoplasia 3: Experience of a Referral Institute. The Israel Medical Association journal","volume":"18","author":"Siegler","year":"2016","journal-title":"Israel Med. Assoc. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/LGT.0b013e31829f52f4","article-title":"Vaginal intraepithelial neoplasia (VaIN 2\/3): Comparing clinical outcomes of treatment with intravaginal estrogen","volume":"18","author":"Rhodes","year":"2014","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1002\/jmv.27311","article-title":"A retrospective study of cytology and HPV genotypes results of 3229 vaginal intraepithelial neoplasia patients","volume":"94","author":"Ao","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1447-0756.2009.01108.x","article-title":"Vaginal intraepithelial neoplasia: A retrospective analysis of clinical features and colpohistology","volume":"36","author":"Boonlikit","year":"2010","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00404-019-05389-1","article-title":"Correlation between referral cytology and in-house colposcopy-guided cytology for detecting early cervical neoplasia","volume":"301","author":"Schulmeyer","year":"2020","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1055\/s-0034-1383042","article-title":"Establishment of the Certification System \u201cGynaecological Dysplasia\u201d in Germany","volume":"74","author":"Beckmann","year":"2014","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Stuebs, F.A., Koch, M.C., Dietl, A.K., Adler, W., Geppert, C., Hartmann, A., Kn\u00f6ll, A., Beckmann, M.W., Mehlhorn, G., and Schulmeyer, C.E. (2022). Cytology and High-Risk Human Papillomavirus Test for Cervical Cancer Screening Assessment. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071748"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1055\/a-1934-1686","article-title":"Standardized Procedures for Patients with Dysplasia and Other Diseases of the Cervix, Vulva, and Vagina at a Certified Dysplasia Unit Prior to the Introduction of the Organized Cervical Cancer Screening Program","volume":"83","author":"Schulmeyer","year":"2023","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_29","first-page":"10","article-title":"F\u00fcr die Koordinationskonferenz Zytologie; Das Prozedere bei auff\u00e4lligen Befunden\u2014Kommentar zur M\u00fcnchner Nomenklatur III","volume":"56","author":"Griesser","year":"2015","journal-title":"FRAUENARZT"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1097\/CEJ.0000000000000287","article-title":"Colposcopic patterns of vaginal intraepithelial neoplasia: A study from the Italian Society of Colposcopy and Cervico-Vaginal Pathology","volume":"27","author":"Sopracordevole","year":"2018","journal-title":"Eur. J. Cancer Prev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1002\/cncy.21521","article-title":"The Pap test and Bethesda 2014","volume":"123","author":"Nayar","year":"2015","journal-title":"Cancer Cytopathol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s00404-018-4953-8","article-title":"Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: A retrospective study","volume":"299","author":"Stuebs","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_33","unstructured":"(2023, May 15). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ijgo.2011.10.033","article-title":"Diagnosis and treatment of vaginal intraepithelial neoplasia","volume":"117","author":"Wee","year":"2012","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/LGT.0b013e318237ec82","article-title":"A simplified classification for describing colposcopic vaginal patterns","volume":"16","author":"Indraccolo","year":"2012","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/LGT.0000000000000446","article-title":"Importance of Colposcopy Impression in the Early Diagnosis of Posthysterectomy Vaginal Cancer","volume":"23","author":"Cong","year":"2019","journal-title":"J. Low. Genit. Tract Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1055\/a-1857-6470","article-title":"HPV High-risk Multiple Infection Is a Key Predictor of Cervical Dysplasia in Diagnostic LEEPs: A Retrospective Cohort Analysis","volume":"82","author":"Wittenborn","year":"2022","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/a-1671-2158","article-title":"Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No.\u2009032\/033OL, May 2021)\u2014Part 1 with Recommendations on Epidemiology, Screening, Diagnostics and Therapy","volume":"82","author":"Beckmann","year":"2022","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1055\/a-1671-2446","article-title":"Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No.\u2009032\/033OL, May 2021)\u2014Part 2 with Recommendations on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities","volume":"82","author":"Fehm","year":"2022","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_40","unstructured":"(2023, July 28). Diagnosis, Therapy, and Follow-Up Care of Vulva Cancer and its Precursors. National Guideline of the German Society and Gynecology and Obstetrics (S2k-Level, AWMF No. 015\/059, August 2015). Available online: https:\/\/www.awmf.org\/uploads\/tx_szleitlinien\/032-042l_S2k_Vaginalkarzinom-Vorstufen-Diagnostik-Therapie-Nachsorge_2018-11.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1002\/ijc.24116","article-title":"Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: A meta-analysis","volume":"124","author":"Clifford","year":"2009","journal-title":"Int. J. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3802\/jgo.2009.20.4.232","article-title":"The utility of the human papillomavirus DNA load for the diagnosis and prediction of persistent vaginal intraepithelial neoplasia","volume":"20","author":"So","year":"2009","journal-title":"J. Gynecol. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.5858\/arpa.2010-0658-OA","article-title":"Correlation of histopathologic follow-up findings with vaginal human papillomavirus and low-grade squamous intraepithelial lesion Papanicolaou test results","volume":"135","author":"Bansal","year":"2011","journal-title":"Arch. Pathol. Lab. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/BF03169000","article-title":"Vaginal cytology following primary hysterectomy for cervical cancer: Is it useful?","volume":"175","author":"Coughlan","year":"2006","journal-title":"Ir. J. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1055\/a-1193-5136","article-title":"Statement of the AGO and AG-CPC on the Aftercare\/Follow-up for Surgical Procedures of the Lower Genital Tract after the Introduction of a New Cancer Screening Guideline","volume":"80","author":"Hillemanns","year":"2020","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref_46","unstructured":"(2023, September 01). Richtlinie des Gemeinsamen Bundesauschusses f\u00fcr Organisierte Krebsfr\u00fcherkennungsprogramme (oKFE-Richtlinie\/oKFE-RL) in der Fassung vom 19 Juli 2018 Zuletzt Ge\u00e4ndert am 12 Mai 2023. Available online: https:\/\/www.g-ba.de\/downloads\/62-492-3189\/oKFE-RL-2023-05-12-iK-2023-07-07.pdf."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/18\/4633\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:53:50Z","timestamp":1760129630000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/15\/18\/4633"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,19]]},"references-count":46,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["cancers15184633"],"URL":"https:\/\/doi.org\/10.3390\/cancers15184633","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,19]]}}}