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Standardization of Terminology and Reporting in Gynecologic Pathology: At Last

Stoler, Mark H. M.D.

International Journal of Gynecological Pathology: January 2013 - Volume 32 - Issue 1 - p 1–2
doi: 10.1097/PGP.0b013e31827c4ebb
EDITORIAL
Free

University of Virginia Health System, Charlottesville, Virginia

The author declares no conflict of interest.

Address correspondence and reprint requests to Mark H. Stoler, MD, Department of Pathology, University of Virginia Health System, 1215 Lee St, HEP RM 3032, Charlottesville, VA 22908. E-mail: mhs2e@virginia.edu.

In this first issue of the 32nd volume of the journal, we have published 2 rather large articles that together present both data and arguments supporting the standardization of terminology and reporting of lesions of the cervix and tumors of the endometrium. The first article is a complete reprinting of the recommendations of the LAST project. LAST stands for the Lower Anogenital Squamous Terminology project, the product of which represents a 2-year effort cosponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Why devote so many pages to an article that has already been published in 2 other journals and on the web? The simple answer is that the report is important to our field and many of our readers, especially our international members, do not have access to the other sources, even in today’s connected world.

The motivation for LAST was derived from the observation that our current knowledge of HPV biology really serves as a unifying force to bring together a spectrum of pathologies that are, histologically, essentially identical, regardless of location in the anogenital tract or for that matter whether the patient is male or female. Yet, the terminology used for these biologically similar lesions varies tremendously across body site, pathology specialty, and clinical subspecialty with a high potential for miscommunication and even inappropriate patient management. The project report starts with a superb focused historical review of the evolution of terminology for what is now known to be the pathology of HPV-associated neoplasia. The main focus of the paper is then a documentation of the process and the rationale for adopting a unified terminology for the precancerous lesions that make up so much of one’s biopsy service. In addition, a systematic review of the utility of biomarkers as an aid to diagnosis is provided, with clear recommendation on when to use and equally importantly when not to use immunohistochemistry on problematic cases.

Another major diagnostic issue and one that may be even more controversial to the reader is the section of the LAST project promoting the unification of terminology for the concept of microinvasive squamous cell carcinoma. Again, a thorough literature review and rationale for the not so new term superficially invasive squamous cell carcinoma, and the criteria for applying it in different anogenital sites are data driven but also not without controversy. One example to tantalize the reader would be examination of the handling of margins in superficially invasive squamous cell carcinoma reporting, in particular when there is only intraepithelial disease on the margin as opposed to invasive cancer compared with one’s current practice. The LAST project concludes with a plan not only for dissemination of the findings but also for monitoring acceptance and implementation. Clearly, the overall goal of LAST was to facilitate communication between pathologists and clinicians by optimizing the accuracy and reproducibility of histologic diagnosis and ultimately improving the quality of patient care.

Along these same lines, and with the same goals in mind, a multinational quadripartite collaboration has resulted in the International Collaboration on Cancer Reporting, issuing a report that is a model for how one might harmonize the various structured cancer reporting systems, commonly referred to as synoptic reports. Focusing on endometrial cancer, this systematic review of the literature then provides clear rationales for what should be the core required elements in every report, as compared with noncore or just recommended elements. This too presents a timely review and essential reading for what pathologists do every day in attempting to guide the clinicians’ management of patients.

©2013International Society of Gynecological Pathologists