The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.LGT200570

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

Teresa M. Darragh, MD;¹ Terence J. Colgan, MD;² J. Thomas Cox, MD;³ Debra S. Heller, MD;³ Michael R. Henry, MD;⁴ Ronald D.Luff, MD;^5,6 Timothy McCalmont, MD;¹ Ritu Nayar, MD;⁷ Joel M. Palefsky, MD;¹ Mark H. Stoler, MD;⁸ Edward J. Wilkinson, MD;⁹Richard J. Zaino, MD;¹⁰ David C. Wilbur, MD,¹¹ for members of the LAST Project Work Groups

¹University of California – San Francisco, San Francisco, CA;

²Mount Sinai Hospital, Toronto, Ontario, Canada;

³UMDNJ-New Jersey Medical School, Newark, NJ;

⁴Mayo Clinic, Rochester, MN;

⁵Quest Diagnostics, Teterboro, NJ;

⁶Thomas Jefferson University, Philadelphia, PA;

⁷Northwestern University Feinberg School of Medicine, Chicago, IL;

⁸University of Virginia Health System, Charlottesville, VA;

⁹University of Florida College of Medicine, Gainesville, FL;

¹⁰Hershey Medical Center, Penn State University, Hershey, PA; and

¹¹Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Archives of Pathology & Laboratory Medicine: October 2012, Vol. 136, No. 10, pp. 1266-1297. 

The CAP-ASCCP LAST project provides recommendations for a unified terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas of the lower anogenital tract.

Abstract

The terminology for human papillomavirus (HPV)–associated squamous lesions of the lower anogenital tract has a long history marked by disparate diagnostic terms derived from multiple specialties. It often does not reflect current knowledge of HPV biology and pathogenesis. A consensus process was convened to recommend terminology unified across lower anogenital sites. The goal was to create a histopathologic nomenclature system that reflects current knowledge of HPV biology, optimally uses available biomarkers, and facilitates clear communication across different medical specialties. The Lower Anogenital Squamous Terminology (LAST) Project was cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology and included 5 working groups; 3 work groups performed comprehensive literature reviews and developed draft recommendations. Another work group provided the historical background and the fifth will continue to foster implementation of the LAST recommendations. After an open comment period, the draft recommendations were presented at a consensus conference attended by LAST work group members, advisors, and representatives from 35 stakeholder organizations including professional societies and government agencies. Recommendations were finalized and voted on at the consensus meeting. The final, approved recommendations standardize biologically relevant histopathologic terminology for HPV-associated squamous intraepithelial lesions and superficially invasive squamous carcinomas across all lower anogenital tract sites and detail the appropriate use of specific biomarkers to clarify histologic interpretations and enhance diagnostic accuracy. A plan for disseminating and monitoring recommendation implementation in the practicing community was also developed. The implemented recommendations will facilitate communication between pathologists and their clinical colleagues and improve accuracy of histologic diagnosis with the ultimate goal of providing optimal patient care.