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CAP-ASCCP Lower Anogenital Squamous Terminology (LAST)
for HPV-associated Lesions

Background

The naming systems used for HPV-associated squamous lesions of the lower anogenital tract (LAT) have varied historically by body site, and even within medical specialties. As our understanding of HPV-associated squamous lesions of the LAT has vastly expanded in recent decades, the terms currently used for histopathologic diagnoses have not changed to reflect this increased understanding. The Lower Anogenital Squamous Terminology Standardization (The LAST Project) was conceived to align LAT terminology for HPV-associated squamous lesions with our current understanding of the similar biology and morphology of these lesions and to improve communication between pathologists making diagnoses and clinicians using these diagnoses so that patients may be managed optimally and consistently.

The Lower Anogenital Squamous Terminology Standardization Consensus Conference was held March 13-14, 2012, in San Francisco, California. The Consensus Conference was co-sponsored by the College of American Pathologists Pathology and Laboratory Quality Center and the ASCCP, and representatives from 35 medical organizations and federal agencies were in attendance to hear, debate, and vote upon key recommendations. The recommendations were based on an extensive literature review of terminology used historically, how terminology influences management of HPV-associated lesions by body sites, and the role of molecular markers in diagnosis.

The primary goals of the conference were:
  • Standardize terminology used for reporting histopathology diagnoses of HPV-related mucocutaneous squamous lesions of the lower genital tract, including intraepithelial lesions and minimally invasive cancers but excluding non-HPV related dermatologic and vulvar lesions.
  • Harmonize terminology across the various lower anogenital tract sites with current evidence-based knowledge regarding the biology of HPV-related squamous lesions and their clinical management.
  • Harmonize the terminology for histopathology with the Bethesda System for reporting gynecologic and anal cytology (if applicable).
  • Assess the use of new technologies to validate proposed terminology standards, and provide guidelines for appropriate use.
Consensus Recommendations

The College of American Pathologists (CAP) Pathology and Laboratory Quality Center and the ASCCP have released joint Consensus Recommendations — The Lower Anogenital Squamous Terminology Standardization Project for HPV-associated Lesions:  Background and Consensus Recommendations. The LAST Project terminology for histopathology is analogous to The Bethesda System for gynecologic cytology for lesions sharing common morphology across all lower anogenital sites.

The LAST Project’s Consensus Recommendations provide a standardized diagnostic histopathologic terminology for squamous lesions associated with human papillomavirus (HPV) across lower anogenital tract body sites, including recommendations for the appropriate use of biomarkers to identify and distinguish these lesions. Thirty-five professional organizations participated in the deliberations, revisions, and approval of the final LAST Consensus Recommendations.

Implementation of the new consensus recommendations will result in more reliable and reproducible diagnoses based on our current knowledge of the biology of HPV – ultimately leading to more effective patient management and improved patient outcomes.

With the new Consensus Recommendations, physicians will receive more consistent biopsy diagnoses to help assess management options, including conservative follow-up or treatment, and more accurately evaluate a patient’s risk of having precancer.

The ASCCP anticipates addressing management issues related to the change in terminology from the 3-tier cervical intraepithelial neoplasia (CIN) to the 2-tier LSIL/HSIL through a consensus process in early 2013. For 2006 Guidelines questions relative to LAST, see the Frequently Asked Questions (FAQs) link below.  


LAST Project Consensus Recommendations and Resources

LAST Project Consensus Recommendations
and Method Supplement


Beginning on June 28, 2012, the final approved recommendations will be released by online joint publication in the Archives of Pathology & Laboratory Medicine and the Journal of Lower Genital Tract Disease. Print publication will follow in both journals.

The Lower Anogenital Squamous Terminology Project Consensus Recommendations

Detailed information about the Project’s 2011-12 comprehensive literature process, evidence grading for biomarkers, the Conflict of Interest (COI) policy, and a list of the participating organizations, etc., may be accessed in the LAST Supplemental Digital Content

LAST Project Consensus Recommendations -
Summary of Recommendations


Download the Summary of the LAST Project Consensus Recommendations

LAST Project Consensus Recommendations -
Frequently Asked Questions (FAQs)


See the Frequently Asked Questions (FAQs) for further information.

Related Links

Archives Early Online Release

CAP Center LAST Resources
LAST Project Resources 

LAST Project PowerPoint Presentation
Share recommendations for terminology and the use of biomarkers with colleagues, grand round presentations, and other educational offerings.

Biomarkers Algorithm for a fast in-hand reference tool.

LAST Online Image Atlas and Self-assessment Module
A free online atlas will be available to review cases inclusive of clinical correlation, biomarkers, and reporting parameters.

ASCCP Educate the Educators' Newsletter (Special LAST Issue)
Read in-depth discussions on the key LAST Work Group topics from Terence Colgan, MD, Tom Cox, MD, Francisco Garcia, MD, MPH, Christina Kong, and Mark Einstein, MD.

CAP TODAY - LATE JULY 2012 Release
Read the President’s Column in July’s CAP TODAY about the CAP-ASCCP LAST Project. Get insight on the impact of the Recommendations for biomarkers and other key outcomes from the LAST Project in July’s CAP TODAY.

Editorial Commentary - BEGINNING in September 2012
Follow-up editorial commentary is being prepared for publication this fall in the following medical journals: Obstetrics & Gynecology, Urology, International Journal of Gynecologic Pathology, Journal of Cutaneous Pathology, and more.


   
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