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Revised Terminology for Cervical Histopathology and Its Implications for Management of High-Grade Squamous Intraepithelial Lesions of the Cervix

Waxman, Alan G. MD, MPH; Chelmow, David MD; Darragh, Teresa M. MD; Lawson, Herschel MD; Moscicki, Anna-Barbara MD

doi: http://10.1097/AOG.0b013e31827001d5
Current Commentary

In March 2012, the College of American Pathologists and American Society for Colposcopy and Cervical Pathology, in collaboration with 35 stakeholder organizations, convened a consensus conference called the Lower Anogenital Squamous Terminology (LAST) Project. The recommendations of this project include using a uniform, two-tiered terminology to describe the histology of human papillomavirus-associated squamous disease across all anogenital tract tissues: vulva, vagina, cervix, penis, perianus, and anus. The recommended terminology is “low-grade” or “high-grade squamous intraepithelial lesion (SIL).” This terminology is familiar to clinicians, because it parallels the terminology of the Bethesda System cytologic reports. Biopsy results using SIL terminology may be further qualified using “intraepithelial neoplasia” (IN) terminology in parentheses. Laboratory p16 tissue immunostaining is recommended to better classify histopathology lesions that morphologically would earlier have been diagnosed as IN 2. p16 is also recommended for differentiating between high-grade squamous intraepithelial lesions and benign mimics. The LAST Project recommendations potentially affect the application of current guidelines for managing cervical squamous intraepithelial lesions. The authors offer interim guidance for managing cervical lesions diagnosed using this new terminology with special attention paid to managing young women with cervical high-grade squamous intraepithelial lesions on biopsy. Clinicians should be aware of the LAST Project recommendations, which include important changes from prior terminology.

Histopathologic terminology for human papillomavirus–associated lesions of the cervix has been revised to a two-tiered system, affecting management of high-grade squamous intraepithelial lesions in young women.

University of New Mexico School of Medicine, Albuquerque, New Mexico; the Virginia Commonwealth University Medical Center, Richmond, Virginia; the University of California, San Francisco, California; and Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: Alan G. Waxman, MD, MPH, Department of Obstetrics and Gynecology, MSC 10 5580, 1 University of New Mexico, Albuquerque, NM 98131-0001; e-mail: awaxman@salud.unm.edu.

The Lower Anogenital Squamous Terminology (LAST) Project was supported by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology.

Financial Disclosure Dr. Darragh has served on the advisory boards of OncoHealth and ArborVita. She has received research supplies for anal ThinPreps from Hologic, Inc. The other authors did not report any potential conflicts of interest.

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.