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<br>David C. Wilbur, MD

David C. Wilbur, MD

New Unified Language for HPV Biology Endeavors to Reduce Miscommunication in Anogenital Cancers and Precancers

Monday, December 17, 2012

“Through their own practice evolution, through the course of time, and through their own professional societies, the professionals in various specialties have developed different names for the same biologic entity. This creates a problem, and it has all come to a head because the biology of HPV-associated disease is now very well understood.”
—David C. Wilbur, MD

The confusion over terminology used by different medical specialty groups has caused miscommunication among clinicians involved in diagnosing HPV-associated anogenital cancers and precancers, resulting in misdiagnoses and mistreatment. 

In response, an influential group of specialists from a variety of backgrounds interested in this subject convened two years ago to study whether to create a standardized terminology for these lesions. Known as the Lower Anogenital Squamous Terminology (LAST) Project, the impetus for the group came from the belief that current knowledge of human papillomavirus (HPV) biology brings together a broad range of pathologies that are histologically identical, regardless of their location in the anogenital tract and irrespective of whether the patient is male or female. The current terminology used for these biologically similar lesions varies tremendously across body site, pathology specialty, and clinical subspecialty.  

In January, ASCP will offer a two-part webinar course, “The Lower Anogenital Squamous Terminology (LAST) Project: Why and How We Can Talk As One,” which presents the LAST Project’s recommendations. The course will be held on Jan. 7 and Jan 14, and will be presented by Mark H. Stoler, MD, FASCP, who participated in the LAST Project. One Continuing Medical Laboratory Education (CMLE) credit will be offered for each of the two one-hour webinars.  

“If you are a dermatologist, you may use different terminology in skin sites than a pathologist would use to describe the same disease process at sites such as cervix,” says David C. Wilbur, MD, Pathologist and Director of Clinical Imaging at Massachusetts General Hospital in Boston, who co-chaired the LAST Project. “As another example, the term ‘microinvasive carcinoma’ has many definitions, which also vary by site. This causes confusion between pathologists and with clinicians treating the disease.

“Through their own practice evolution, through the course of time, and through their own professional societies, the professionals in various specialties have developed different names for the same biologic entity. This creates a problem, and it has all come to a head because the biology of HPV-associated disease is now very well understood.”

The LAST project spent two years studying the issues before developing a set of recommendations for a standardized vocabulary to improve communication and more effectively allow management of this single disease over multiple sites. The recommendations were presented, voted on, and approved at a consensus conference held last March. Representatives of more than 35 medical organizations and federal agencies participated in the conference.  

The ASCP course will review the process and the rationale for adopting a unified terminology for the precancerous/cancerous lesions that make up so much of one’s biopsy service. Part one will focus on the biologic foundation for the LAST recommendations. It will also review the utility of biomarkers as an aid to diagnosis with clear recommendations on when to use, and when not to use, immunohistochemistry on problematic cases. Part two will present the new, standardized terminology for precancerous lesions of all the relevant body sites.

“The ultimate goal of this effort is to improve health care,” Dr. Wilbur says.

 


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