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The 2015 International Society for the Study of Vulvovaginal Disease (ISSVD) Terminology of Vulvar Squamous Intraepithelial Lesions

Bornstein, Jacob MD, MPA; Bogliatto, Fabrizio MD; Haefner, Hope K. MD; Stockdale, Colleen K. MD, MS; Preti, Mario MD; Bohl, Tanja G. MD; Reutter, Jason MD for the ISSVD Terminology Committee

doi: 10.1097/AOG.0000000000001285
Contents: Consensus Statement

OBJECTIVES: The impact of terminology for vulvar intraepithelial lesions has been significant over the years, because it has affected diagnosis, treatment, and research. The introduction of the Lower Anogenital Squamous Terminology (LAST) in 2012 raised 2 concerns in relation to vulvar lesions: firstly, the absence of reference to “differentiated vulvar intraepithelial neoplasia” (differentiated VIN) could lead to its being overlooked by health care providers, despite its malignant potential. Secondly, including the term “low-grade squamous intraepithelial lesion” (LSIL) in LAST recreated the potential for overdiagnosis and overtreatment for benign, self-limiting lesions.

MATERIALS AND METHODS: The International Society for the Study of Vulvovaginal Disease (ISSVD) assigned the terminology committee the task of developing a terminology to take these issues into consideration. The committee reviewed the development of terminology for vulvar SILs with the previous 2 concerns in mind and reviewed several new terminology options.

RESULTS: The final version accepted by the ISSVD contains the following: 1) Low-grade SIL of the vulva or vulvar LSIL, encompassing flat condyloma or human papillomavirus effect. 2) High-grade SIL or vulvar HSIL (which was termed “vulvar intraepithelial neoplasia usual type” in the 2004 ISSVD terminology). 3) Vulvar intraepithelial neoplasia, differentiated type.

CONCLUSION: The advantage of the new terminology is that it includes all types of vulvar SILs, it provides a solution to the concerns in relation to the application of LAST to vulvar lesion, and it is in accordance with the World Health Organization classification as well as the LAST, creating unity among clinicians and pathologists.

The 2015 ISSVD terminology of vulvar squamous intraepithelial lesions resolves concerns raised with regard to application of the Lower Anogenital Squamous Terminology to vulvar lesions.

Departments of Obstetrics and Gynecology, Galilee Medical Center and Bar-Ilan University Faculty of Medicine, Nahariya, Israel, Chivasso Civic Hospital, Chivasso, and University of Turin, Turin, Italy, University of Michigan Health System, Ann Arbor, Michigan, and University of Iowa, Iowa City, Iowa; Jean Hailes Medical Center for Women, Monash, Australia; and Piedmont Pathology Associates, Hickory, North Carolina.

Corresponding author: Jacob Bornstein, MD, MPA, Department of Obstetrics and Gynecology, Galilee Medical Center, P.O. Box 21, Nahariya 22100, Israel; e-mail:

Financial Disclosure Dr. Haefner is affiliated with Advisory Board of Merck Co., Inc. The other authors did not report any potential conflicts of interest.

This article is published simultaneously in the Journal of Lower Genital Tract Disease and Obstetrics & Gynecology. ©2015 the American Society for Colposcopy and Cervical Pathology.

The authors thank Dr. Christopher P. Crum, Dr. Teresa M. Darragh, Dr. Debra S. Heller, Dr. James Scurry, and Dr. Edward J. Wilkinson for their useful comments in addressing the concerns of this committee.

Members of the ISSVD 2013–2015 terminology committee included Jacob Bornstein MD, MPA (Chairman). The other members are the following: Fabrizio Bogliatto, MD, Tanja G. Bohl, MD, Deborah Coady, MD, Hope K. Haefner, MD, Mario Preti, MD, Jason Reutter, MD, Priya Selva-Nayagam, MD, Colleen K. Stockdale, MD, MS, and Marc Van-Beurden, MD.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.