Patient Management Using Lower Anogenital Squamous Terminology

Abstract

Lower Anogenital Squamous Terminology (LAST) was designed to enhance communication between pathologists and clinicians and to bring terminology more in line with current understanding of pathophysiology. Nonetheless, it creates some challenges for patient management. The American Society for Colposcopy and Cervical Pathology 2012 updated guidelines for the management of abnormal cervical cancer screening tests and cancer precursors are generally accepted as standard of care. However, these guidelines do not integrate LAST and provide only brief guidance for their use. Low-grade squamous intraepithelial lesion (LSIL) generally maps to treatment algorithms for cervical intraepithelial neoplasia 1 (CIN1), and high-grade squamous intraepithelial lesion (HSIL) generally maps to treatment algorithms for CIN2 and CIN3. Lack of long-term follow-up data for biopsies placed into LSIL or HSIL categories via use of p16 testing of CIN2 on histologic appearance creates some concerns for clinicians. In addition, merging CIN2 and CIN3 into a single category makes it more difficult to apply recommendations for management of high-grade lesions in young women. As the LAST is new, it was not possible to present actual cases that have been managed with this terminology. Instead, we present 3 hypothetical cases designed to illustrate management issues related to LAST. Separate cases are presented for management of LSIL, HSIL, and HSIL in young women.