Lara C. Pullen, PhD

September 24, 2014

CHICAGO — New human papillomavirus (HPV) guidelines recently adopted by the World Health Organization (WHO) are helping physicians obtain more reproducible and consistent biopsy diagnoses of squamous lesions, delegates learned here at the College of American Pathologists (CAP) 2014 meeting.

The recommendations will help physicians more accurately evaluate a patient's risk for precancer, steering committee member and presenter Teresa Darragh, MD, from the University of California at San Francisco, told Medscape Medical News. This should result in more effective patient management and improved outcomes, she said.

The guidelines, a joint effort of CAP and the American Society for Colposcopy and Cervical Pathology, are part of the Lower Anogenital Squamous Terminology Standardization (LAST) Project for HPV-Associated Lesions.

Committee members acknowledge the inevitability of diagnostic variation, and attempted to minimize problems by limiting the number of histopathologic classification tiers. They also recommend the judicious use of biomarkers.

The approach, recently endorsed in the WHO Classification of Tumours of Female Reproductive Organs Blue Book, is gaining ground internationally and is translating terminology that should improve communication among pathologists and their clinical colleagues.

Different specialties used disparate diagnostic terms when discussing HPV-associated squamous lesions of the lower anogenital tract. Some of the terminology was outdated and did not reflect the emerging understanding of the biology and pathogenesis of HPV.

According to the committee, it began by assuming that there is a known unified epithelial biology that underlies HPV-associated squamous neoplasia in males and females. After acknowledging that each patient's sample is only a single representation of the patient's true biology, they designed a system to describe current and future cancer risk.

Terms like carcinoma in situ and dysplasia (mild, moderate, and severe) are now obsolete.

The committee also made recommendations for the optimal use of available biomarkers. After reviewing research for all of the commercial options, the team only recommended the use of p16.

Dr. Darragh reports financial relationships with Hologic, OncoHealth, Roche, Ventana, and TheVax.


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