Prof. Silvio Tatti MD, MSc, Phd, FACOG
Past President IFCPC
Hospital de Clínicas “José de San Martín”
University of Buenos Aires
Introduction and
Update of the new
IFCPC nomenclature
Professor Silvio Tatti
Past President IFCPC

Presented at the 7th world
congress of the IFCPC in
Rome, Italy in 1990.
Developed by a
Nomenclature Committee
headed by Adolf Stafl
4º IFCPC Nomenclature - 2011
Jim Bentley - Canada
Jacob Bornstein - Israel
Peter Bosze – Hungary
Frank Girardi – Austria
Hope Haefner - USA
Patrick Walker – UK
Silvio Tatti – Argentina
IFCPC board
Michael Menton – Germany
Myriam Perrota – Argentina/
Walter Prendiville – Ireland
Peter Russell - Australia
Mario Sideri – Italy
Bjorn Strander – Sweden
Aureli Torne – Spain
Transformation Zone
Classification
Type 1
Completely
ectocervical
Fully visible
small or large
Transformation Zone
Classification
Type 2
has endocervical
component
Fully visible
may have
ectocervial
component which
may be small or
large
Type 3
has endocervical
component
is not fully visible
may have ectocervial
component which may
be small or large
2011 IFCPC colposcopic terminology - addendum
Excision
treatment
types


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
2011 IFCPC colposcopic terminology - addendum
Excision
treatment
types
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
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.
Height
Depth
Length
Thickness
Circumference
Excision treatment Excision type 1,2,3
types
Excision specimen
dimensions
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
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, 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).
Reflects HPV biology and clinical management
Infection &
Precancer
Biology
&
Management
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




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
A Distinct Biologic Stage?
Ugly Looking CIN1?
Not So Ugly CIN3?
Teresa Darragh MD
LSIL
CIN 2
P16P16+
HSIL
LAST terminology for
the cervix, vulva and
vagina
WHO Blue Book - April 2014
HSIL
vs
MIMIC of HSIL
p16 positive = HSIL
Teresa Darragh MD
WHO Blue Book - April 2014
HSIL
vs
REACTIVE
p16 negative = Reactive
Teresa Darragh
MD
Cervical
Biopsy
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
[email protected]