Title: Clinical Characteristics, HPV Involvement, and Demographic Risk Factors in Women
with Cervical Intraepithelial Neoplasia Complicated by Vaginal Intraepithelial Neoplasia
Version: 1 Date: 21 Feb 2024
Reviewer's report:
Dear authors,
you compare 50 cases of CIN combined with VAIN and 160 cases of CIN only. But CIN is
about 100 times more common diagnosis than VAIN and that's why the numbers in both files
do not make sense. I leave it to the editor decision, if he will accept the article.
Another comments
Lines 69-74
The low incidence of VAIN could be attributed to its often asymptomatic nature and reliance
on singular diagnostic methods like the ThinPrep cytologic test (TCT) or colposcopic biopsies.
The diagnosis relies on pathological examination and its preliminary screening relies on either
thinprep cytologic test (TCT) or colposcopic application of 5% acetic acid multipoint biopsy5
Comment: I do not understand. Diagnosis of what? VAIN diagnosis? You repeat the same thing
and the second sentence makes no sense. The diagnosis of VAIN does not rely on a cytology
test. A colposcopic examination should be performed with the application of 5% acetic acid and
then a colposcopically guided biopsy may be performed.
Lines 197-199
For skin infections, HPV types can be categorized into low-risk (e.g., 1, 2, 3, 4, 7, 10, 12, 15)
and high-risk types (e.g., 5, 8, 14, 17, 20, 36, 38).
Comment:  Missing citation.
Lines 199-201
Similarly, for mucosal infections, low-risk types include 6, 11, 32, 34, 40, 42, 43, 44, 53, 54,
and high-risk types include 16, 18, 30, 31, 33, 35, 39.
Comment:  You write nonsense. The International Agency for Research on Cancer (IARC) of
WHO distinguishes 3 groups of HPV. HR genotypes include HPV classified into group 1 (HPV
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) and group 2A (HPV 68). According to the IARC,
13 HPV genotypes are currently classified into the HR HPV group, HPV genotypes 16, 18, 31,
33 and 45 are considered the most important for the development of human malignancies.
Source: Bouvard V, Baan R, Straif K et al. A review of human carcinogens--Part B: biological
agents. Lancet Oncol 2009; 10(4): 321-322.)
Lines 224-227
The latest evidence shows that surgical treatment of the CIN was associated with an increased
risk of preterm delivery, lower birth weight and preterm premature rupture of membrane before
37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure.
Comment:  The abbreviations CKC and LLETZ should be explained. It is better to cite the
Cochrane database (Kyrgiou M et al. Fertility and early pregnancy outcomes after conservative
treatment for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2015 Sep
29;2015(9):CD008478. doi: 10.1002/14651858.CD008478.pub2. PMID: 26417855; PMCID:
PMC6457639. )
Line 233
And this article is not thorough enough
Table 1
The percentages in brackets in Numbers of sexual partners and Numbers of pregnancies are
missing
Table 2
The first line – add total number of subjects in each group = CIN group + CIN combined with
VAIN group
Table 3
The first line – add total number of subjects in each group
The percentages in brackets after numbers are missing