Understanding How HPV Biology Impacts Practical Diagnostic Pathology: At LAST

Mark H. Stoler, MD

Presentation Date: February 5, 2013; Expiration Date: February 5, 2016

LAST stands for the Lower Anogenital Squamous Terminology Project, the product of which represents a 2-year effort co-sponsored by the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. The motivation for LAST was derived from the observation that our current knowledge of HPV biology really serves as a unifying force to bring together a spectrum of pathologies that are histologically, essentially identical, regardless of location in the anogenital tract or for that matter whether the patient is male or female. Yet, the terminology used for these biologically similar lesions varies tremendously across body site, pathology specialty, and clinical subspecialty with a high potential for miscommunication and even inappropriate patient management.

Dr. Stoler presents the biologic foundation for the LAST recommendations. In addition, he reviews the utility of biomarkers as an aid to diagnosis with clear recommendations on when to use, and equally as important, when not to use immunohistochemistry on problematic cases. Further he discusses the implication for terminology and ramifications for the interaction and communication between pathologists and clinicians currently and in the potential near future.