Why LAST? Polishing the Gold Standard

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Abstract

Pathologic diagnoses are often considered the gold standard, the truth on which many clinical management decisions are based. Yet, morphologic interpretations are inherently subjective and may result in significant diagnostic error and interobserver variability. Mixed with the plethora of potentially confusing medical terms that have been applied to human papillomavirus–associated squamous lesions of the lower anogenital tract, miscommunication and potential patient harm may ensue. Mirroring the Bethesda System for gynecologic cytology, the Lower Anogenital Tract Squamous Terminology (LAST) Project, jointly sponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology, recognizes both the strengths and limitations of histopathologic diagnoses. Based on our current understanding of human papillomavirus–associated infection and precancer, the LAST Project recommends a 2-tiered terminology for squamous intraepithelial lesions and couples it with the judicious use of the biomarker, p16, to enhance diagnostic accuracy. The LAST Project also recommends a united approach to superficially invasive squamous carcinomas of the lower anogenital tract, emphasizing their potential amenability to conservative therapy. Adoption of the LAST Project’s recommendations, in essence, polishes the gold standard: improving diagnostic precision, communication between pathologists and our clinical colleagues, and, ultimately, patient care.

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