(026) CORRELATIONS BETWEEN IMMUNOHISTOCHEMICAL AND PAIN-RELATED ASSESSMENTS IN NEUROPROLIFERATIVE VESTIBULODYNIA: AN UPDATE IN 102 PATIENTS
Notice bibliographique
Résumé
Abstract Introduction Neuroproliferative vestibulodynia (NPV) is confirmed by immunohistochemical (IHC) staining of excised vestibular specimens. Compared to controls, specimens from NPV patients contain >8 mast cells per high-power field (HPF) and increased density of nerve endings. A 2024 publication of 65 patients with IHC confirmed diagnosis of NPV assessed correlations between patient-reported pain-related measures and computer-assisted histometry of excised vestibulectomy specimen IHC stained with CD117 (marker for mast cells) and PGP9.5 (marker for nerves). There were no statistically significant correlations between mean fractional area of immunopositive staining and multiple pain-related assessment scores; we hypothesized that there was a threshold of mast cell and nerve accumulation, above which there was no increase in pain scores. Objective To determine whether reviewing additional charts of NPV patients would result in statistically significant correlations between immunopositive staining and pain-related assessments. Methods Charts of patients who underwent complete vestibulectomy between January 2023 and February 2024 were reviewed and their data added to the original set from the 2024 publication. Tissue sections from the 1:00-11:00 and/or 12:00 regions of the vestibule were examined. High-resolution images were captured using a microscope at 100x and 200x magnification. At least 2 photomicrographs/magnification were taken for each tissue section, including epithelial basement membrane and adjacent subepithelium, representative of the majority of immunostained tissue (Fig. 1). Fractional area of positive immunostaining of all photomicrographs was determined using computer-assisted histometry by ImageJ. Mean fractional area was determined from 3 measurements of each photomicrograph. Correlations were made between density of IHC staining and the following assessments: Female Sexual Function Index (FSFI) pain domain, Short Form McGill Pain Questionnaire (SF-MPQ), cotton-tipped swab testing (1:00–11:00 and 12:00 vestibule), and patient global impression of improvement (PGI-I). Data were analyzed using Spearman correlations and the Mann–Whitney test. Results 37 charts of NPV patients were added to the original 65, resulting in 102 patients reviewed who underwent vestibulectomy between November 2019 and February 2024, for a total of 1091 photomicrographs analyzed. In the previous study, there were no statistically significant correlations between CD117- or PGP9.5-immunopositive mean fractional area and the FSFI pain domain, SF-MPQ scores, cotton-tipped swab test pain score, or PGI-I. Adding IHC data from the additional 37 patients confirmed no statistically significant correlations between CD117 or PGP9.5 immunopositive mean fractional area and the multiple pain assessments (Fig. 2). Conclusions The lack of correlations between immunopositive staining and multiple clinical assessment scores in patients with severe vestibular pain suggests a non-linear threshold for mast cell accumulation and nerve proliferation that results in pain symptoms for NPV patients. Adding data from an additional 37 patients for a total of 102 patients did not change this observation. We hypothesize that once a theoretical threshold for accumulation of mast cells and nerves is reached, additional accumulation does not result in worsened clinical symptoms. This can account for the variability in pain scores among NPV patients and explain why a complete vestibulectomy may be the appropriate treatment no matter the results of the multiple pain assessments once pain is experienced from clinically suspected NPV. Disclosure No.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».