Evaluation of the Vulvar Cancer Histology Code Reported by Central Cancer Registries: Importance in Epidemiology
David A Siegel, Reda Wilson, Edward J Wilkinson
1From the Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia (Dr Siegel); the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion (Dr Saraiya and Mss Wilson and Watson), the Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases (Drs Gargano and Unger), and the Epidemic Intelligence Service (Drs Gargano and Unger), Centers for Disease Control and Prevention, Atlanta, Georgia; the Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville (Dr Wilkinson); the University of Hawaii Cancer Center, University of Hawaii, Honolulu (Dr Hernandez); the Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California (Dr Goodman); and the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City (Dr Lynch).
Context:
-Knowing the subtype of vulvar cancer histology is important for estimating human papillomavirus-related cancer etiology. Surveillance of human papillomavirus-related vulvar cancers informs public health decisions related to vaccination against human papillomavirus.
Objective:
-To assess the accuracy of registry classifications of vulvar cancer and determine the histologic classification of cases reported as not otherwise specified.
Design:
-Pathology specimens were collected from Florida, Iowa, and Hawaii cancer registries. Registry diagnosis was compared with the pathology report from the medical record and a single expert study histology review of a representative histologic section from each case.
Results:
-The study included 60 invasive vulvar squamous cell carcinoma (SCC) cases, 6 Paget disease cases, 2 basal cell carcinoma cases, and 53 in situ cases. Comparing subtypes of invasive vulvar SCC, the registry agreed with the pathology report classification in 49 of 60 cases (81.7%). Study histology review identified the same SCC subtype as the registry in 9 of 60 cases (15.0%) and the same SCC subtype as the pathology report in 11 of 60 cases (18.3%). Whereas the registry and pathology reports classified 37 and 34 cases, respectively, as being SCC not otherwise specified, the study histology review identified a more specific subtype in all cases.
Conclusions:
-Subtypes of vulvar cancer were frequently recorded as not otherwise specified in the cancer registry primarily because the pathology report often did not specify the histologic subtype. Vulvar cancer registry data are useful for tracking broad diagnostic categories, but are less reliable for vulvar cancer subtypes.
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