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The LAST guidelines in clinical practice: implementing recommendations for p16 use.

Lani K Clinton1, Kyle Miyazaki2, Asia Ayabe2

  • 1From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and John A. Burns School of Medicine, University of Hawaii, Honolulu. lclinton@hawaii.edu.

American Journal of Clinical Pathology
|November 18, 2015
PubMed
Summary

Implementing p16 Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions (LAST) guidelines significantly increased p16 use in cervical biopsies. This led to a higher positive predictive value for high-grade squamous intraepithelial lesions (HSIL).

Keywords:
Cervical pathologyGynecologic pathologyLAST guidelinesp16

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Area of Science:

  • Gynecologic Pathology
  • Cervical Cancer Screening
  • HPV-Associated Lesions

Background:

  • The p16 Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions (LAST) guidelines were implemented to standardize terminology and improve management.
  • Assessing the impact of these guidelines on p16 biomarker utilization and diagnostic outcomes is crucial for cervical cancer prevention strategies.

Purpose of the Study:

  • To evaluate the effect of implementing the p16 LAST guidelines on p16 biomarker usage and follow-up in cervical biopsy specimens.
  • To compare p16 use rates, high-grade squamous intraepithelial lesion (HSIL) detection, and positive predictive values before and after guideline adoption.

Main Methods:

  • A retrospective review of cervical biopsy specimens diagnosed by two pathologists was conducted, comparing data from before and after the implementation of the p16 LAST guidelines.
  • Rates of p16 use, reasons for use, HSIL detection, and follow-up were calculated and analyzed across the two periods.

Main Results:

  • Overall p16 use increased significantly from 2.8% to 6.2% post-guideline implementation (P < .001).
  • The positive predictive value of p16-positive HSIL substantially improved from 48% to 76% (P < .05).
  • Specific recommendations within the LAST guidelines (2 and 4) showed increased utilization, rising from 0.16% and 0% to 1.4% and 1.9% respectively (P < .0001).

Conclusions:

  • The implementation of the p16 LAST guidelines led to a significant increase in the utilization of the p16 biomarker in cervical biopsies.
  • Adoption of the p16 LAST guidelines demonstrably improved the positive predictive value of p16-positive HSIL, enhancing diagnostic accuracy.