Prof. Silvio Tatti MD, MSc, Phd, FACOG Past President IFCPC Hospital de Clínicas José de San Martín University of Buenos Aires

Transcription

1 Prof. Silvio Tatti MD, MSc, Phd, FACOG Past President IFCPC Hospital de Clínicas José de San Martín University of Buenos Aires

2 Introduction and Update of the new IFCPC nomenclature Professor Silvio Tatti Past President IFCPC

3 Presented at the 7 th world congress of the IFCPC in Rome, Italy in Developed by a Nomenclature Committee headed by Adolf Stafl

4 4º IFCPC Nomenclature Jim Bentley - Canada Jacob Bornstein - Israel Peter Bosze Hungary Frank Girardi Austria Patrick Walker UK Silvio Tatti Argentina IFCPC board Hope Haefner - USA Michael Menton Germany Myriam Perrota Argentina/ Walter Prendiville Ireland Peter Russell - Australia Mario Sideri Italy Bjorn Strander Sweden Aureli Torne Spain

5 Type 1 Transformation Zone Completely ectocervical Fully visible small or large Classification

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7 Type 2 Transformation Zone has endocervical component Fully visible may have ectocervial component which may be small or large Classification

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9 Type 3 has endocervical component is not fully visible may have ectocervial component which may be small or large

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11 Excision treatment types 2011 IFCPC colposcopic terminology - addendum Why do we need a nomenclature of excision treatment types? To avoid using conization, cone biopsy Big loop excision, small loop excision To educate ourselves with the current understanding of how extensive an excision should be done

12 Excision treatment types 2011 IFCPC colposcopic terminology - addendum Type 1 - resection of a type 1 TZ Type 2 resection of a type 2 TZ Type 3 resection of a type 3 TZ, glandular disease, suspected micro invasion or as a repeat treatment Courtesy of Dr Prendiville

13 Courtesy of Dr Prendiville

14 Why do we need a nomenclature of the size of the excised specimen? The dimensions of the excised specimen are significant to future pregnancy outcome: Systematic reviews documented an increase in pre-term delivery with an increase in the size of the excised specimen Studies sometimes used : cone height, cone depth, etc.

15 Height Depth Length Thickness Circumference

16 Excision treatment types Excision specimen dimensions Excision type 1,2,3 Length - the distance from the distal/external margin to the proximal/internal margin Thickness - the distance from the stromal margin to the surface of the excised specimen. Circumference (Optional)- the perimeter of the excised specimen

17 Terminology : 3 fundamental principles 1.Communicate clinically relevant information from the laboratory to the patient s health care provider. 2.Uniform and reasonably reproducible across different pathologists and laboratories and also flexible enough to be adapted in a wide variety of lab settings and geographic locations 3.Reflect the most current understanding of the disease process These principles were adopted by the LAST Project Robert J. Kurman, MD Forward to the Bethesda Atlas, 2 nd edition

18 What is LAST? A unified histopathological nomenclature Use a single set of diagnostic term It is recommended for all HPV-associated preinvasive squamous lesions of the lower anogenital tract (LAT).

19 Reflects HPV biology and clinical management Infection & Precancer

20 Biology & Management

21 Biology & Management

22 The difficulty of pathologists (H E) is to interpretate IN2 lesions The interobserver agreement for CIN 2 is Benign Kappa 0.52 CIN1 Kappa 0.24 CIN2 Kappa 0.20 CIN3+ Kappa 0.61 Robertson et al. J Clin Pathol 1989;42:231-8.

23 Distribution of 56 cases according to number of different diagnoses by 22 pathologists From: Ceballos KM: Int J Gynecol Pathol, Volume 27(1).January Teresa Darragh MD

24 Negative LSIL HSIL AIS Teresa Darragh MD

25 A Distinct Biologic Stage? Ugly Looking CIN1? Not So Ugly CIN3? An equivocation that is NOT reproducible A representation of incomplete sampling ~2/3s HSIL; ~1/3 LSIL Does not reflect our current understanding: infection vs. precancer A management safety net? Teresa Darragh MD

26 CIN 2 P16- P16+ LSIL HSIL

27 LAST terminology for the cervix, vulva and vagina

28 WHO Blue Book - April 2014 HSIL vs MIMIC of HSIL

29 p16 positive = HSIL Teresa Darragh MD

30 WHO Blue Book - April 2014 HSIL vs REACTIVE

31 Teresa Darragh Cervical MD Biopsy p16 negative = Reactive

32 LAST Recommendations The morphology suggest HSIL vs mimic a precancer lesion The morphology suggest CIN 2 and we need to apply p16 to define if this is HSIL or LSIL To define a disagreement in between two patholgists. One think it is a IN2 and the other IN3 Do not recommend the use of p16 in a define IN1, -IN or Cervical cancer

33 Conclusions In the near future the implementation of preventive HPV vaccines in adolescents will produce changes in frequency of HPV lesions in this population and in screening methods (use of molecular tests). Special Circumstances The morphology suggests LGSIL, but the cytology results ASC-H, ACG or ASC-US/VPH+16

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