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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

Darragh, Teresa M. M.D.; Colgan, Terence J. M.D.; Thomas Cox, J. M.D.; Heller, Debra S. M.D.; Henry, Michael R. M.D.; Luff, Ronald D. M.D.; McCalmont, Timothy M.D.; Nayar, Ritu M.D.; Palefsky, Joel M. M.D.; Stoler, Mark H. M.D.; Wilkinson, Edward J. M.D.; Zaino, Richard J. M.D.; Wilbur, David C. M.D.For Members of the LAST Project Work Groups

International Journal of Gynecological Pathology: January 2013 - Volume 32 - Issue 1 - p 76–115
doi: 10.1097/PGP.0b013e31826916c7

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 co-sponsored by the College of American Pathologists (CAP) and the American Society for Colposcopy and Cervical Pathology (ASCCP) and included 5 working groups; three 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 upon 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 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.

Supplemental Digital Content is available in the text.

University of California (T.M.D., T.M., J.M.P.) – San Francisco, San Francisco, CA

Mount Sinai Hospital (T.J.C.), Toronto, ON, Canada

University of California (J.T.C.) – Santa Barbara Student Health Service (retired), Santa Barbara, CA

UMDNJ-New Jersey Medical School (D.S.H.), Newark, NJ

Mayo Clinic (M.R.H.), Rochester, MN

Quest Diagnostics (R.D.L.), Teterboro, NJ, Thomas Jefferson University, Philadelphia, PA

Northwestern University Feinberg School of Medicine (R.N.), Chicago, IL

University of Virginia Health System (M.H.S.), Charlottesville, VA

University of Florida College of Medicine (E.J.W.), Gainesville, FL

Hershey Medical Center (R.J.Z.), Penn State University, Hershey, PA

Massachusetts General Hospital (D.C.W), Harvard Medical School, Boston, MA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

This article is reprinted from the Journal of Lower Genital Tract Disease, 2012, Volume 16, Number 3, pages 205–242.

Disclosure: ASCCP and the CAP provided the funding for this project; no industry funds were used in the development of the consensus statements and recommendations.

The authors declare no conflict of interest.

Précis: 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.

Address correspondence and reprint requests to Teresa M. Darragh, MD, UCSF/Mt. Zion Medical Center Depts. of Pathology and Obstetrics, Gynecology and Reproductive Science 1600 Divisadero Street, Room B618 San Francisco, CA 94115. E-mail:

©2013International Society of Gynecological Pathologists