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  • Prof. Silvio Tatti MD, MSc, Phd, FACOGPast President IFCPC

    Hospital de Clnicas Jos de San Martn University of Buenos Aires

  • Professor Silvio Tatti Past President IFCPC

    Introduction and Update of the new

    IFCPC nomenclature

  • Presented at the 7th world congress of the IFCPC in Rome, Italy in 1990. Developed by a Nomenclature Committee headed by Adolf Stafl

  • Jim Bentley - Canada

    Jacob Bornstein - Israel

    Peter Bosze Hungary

    Frank Girardi Austria

    Hope Haefner - USA

    Michael Menton Germany

    Myriam Perrota Argentina/

    Walter Prendiville Ireland

    Peter Russell - Australia

    Mario Sideri Italy

    Bjorn Strander Sweden

    Aureli Torne Spain

    Patrick Walker UK

    Silvio Tatti Argentina

    IFCPC board

    4 IFCPC Nomenclature - 2011

  • Type 1Completely ectocervicalFully visiblesmall or large

    Transformation Zone Classification

  • Type 2has endocervical componentFully visiblemay have ectocervial component which may be small or large

    Transformation Zone Classification

  • Type 3has endocervical componentis not fully visiblemay have ectocervial component which may be small or large

  • 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

    2011 IFCPC colposcopic terminology - addendum

    Excision treatment types

    Why do we need a nomenclature of excision treatment types?

  • 2011 IFCPC colposcopic terminology - addendum

    Excision treatment types

    Type 1 - resection of a type 1 TZ Type 2 resection of a type 2 TZType 3 resection of a type 3 TZ, glandular disease, suspected micro invasion or as a repeat treatment

    Courtesy of Dr Prendiville

  • Courtesy of Dr Prendiville

  • 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.

  • Length

    Thickness

    Circumference

    HeightDepth

  • Excision type 1,2,3

    Excision treatment types

    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

    Excision specimen dimensions

  • Terminology : 3 fundamental principles

    1.Communicate clinically relevant information from the laboratory to the patients health care provider.2.Uniform and reasonably reproducibleacross different pathologists and laboratories and also flexible enough to be adapted in a wide variety of lab settings and geographic locations3.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, 2nd edition

  • 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).

  • PrecancerInfection &

    Reflects HPV biology and clinical management

  • Management Biology &

  • Biology & Management

  • 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.

  • Distribution of 56 cases according to number of different diagnoses by 22 pathologists From: Ceballos KM: Int J Gynecol Pathol, Volume 27(1).January 2008.101-107

    Teresa Darragh MD

  • Negative

    LSIL

    HSIL

    AIS

    Teresa Darragh MD

  • 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

    A management safety net?Does not reflect our current understanding:infection vs. precancer

    Teresa Darragh MD

  • CIN 2

    LSIL

    HSIL

    P16-

    P16+

  • LAST terminology for the cervix, vulva and

    vagina

  • WHO Blue Book - April 2014

    HSILvs

    MIMIC of HSIL

  • p16 positive = HSILTeresa Darragh MD

  • WHO Blue Book - April 2014

    HSILvs

    REACTIVE

  • p16 negative = Reactive

    Cervical BiopsyTeresa Darragh MD

  • 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

  • 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

  • siltatti@fibertel.com.ar

    Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix clinical perspective -Diapositiva numero 22nd IFCPC Nomenclature - 1990Diapositiva numero 4Diapositiva numero 5Diapositiva numero 6Diapositiva numero 7Diapositiva numero 8Transformation Zone ClassificationDiapositiva numero 10Diapositiva numero 11Diapositiva numero 12Diapositiva numero 13Excision specimen dimensionsExcision specimen dimensionsDiapositiva numero 16The Bethesda System: A Historical PerspectiveDiapositiva numero 182-tiered system: LSIL & HSILHPV Biology: Infection vs. PrecancerBiomarkers: Further reduce diagnostic variationDiapositiva numero 22Interobserver variability: Histologic diagnosesDiapositiva numero 24What is -IN2?DEFINITIONSWHO Blue BookApril 2014Diapositiva numero 28DDx: HSIL vs. MimicDiapositiva numero 30DDx: HSIL vs. ReactiveWhen do we use p16?Diapositiva numero 33Diapositiva numero 34