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

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.

Preliminary results of a screening program for anal cancer and its precursors for HIV-infected men who have sex with men in Vigo-Spain

“…This would explain why only three (1.5%) of our patients with NAMC cytology and concurrent HR-HPV infection presented a histological HSIL lesion, illustrating the limited positive predictive value that the presence of HPV has for identifying HSIL lesions. This has already been reported in the literature (25).…”

“…We used the terminology recommendations from the Lower Anogenital Squamous Terminology Standardization Project (LAST Project 2012) (25). The recommended terminology is: anal intraepithelial neoplasia type 1, LSIL (AIN-1); anal intraepithelial neoplasia type 2, HSIL (AIN-2); and anal intraepithelial neoplasia type 3 HSIL (AIN-3).…”

Relevance of the Pap Test: A Report of HPV-DNA Test-Negative High-Grade Squamous Intraepithelial Lesions of the Female Lower Genital Tract

“…HPV is recognized as the most common etiology of premalignant and malignant squamous lesions of the cervix and vagina [8]. In this clinical study, we presented HPV-DNA test-negative Pap-positive cervicovaginal squamous intraepithelial lesions with HPV genotyping data from corresponding surgical tissue biopsies.…”

“…The high-risk human papillomaviruses (hrHPV) are recognized as the cause of the vast majority of cervical and vaginal intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC) [2,4,5,6]. The most common hrHPV types identified include types 16 and 18 while types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 are also recognized as high-risk with the potential to cause SCC or precancerous high-grade squamous intraepithelial lesions (HSIL) that include CIN2 and CIN3 [7,8]. An additional subset is also believed to be carcinogenic, based on similarities to the known hrHPV types [3,9].…”

The Pap Test and Bethesda 2014

“…The 2-tiered terminology of LSIL and HSIL used in TBS is now also recommended by the World Health Organization, the ASCCP, and the College of American Pathologists for reporting histopathology of HPV-associated squamous lesions of the lower anogenital tract [16,17,18,19]. …”