title: The LAST guidelines in clinical practice: implementing recommendations for p16 use.
abstract: OBJECTIVE
  To determine the impact of implementing p16 Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions (LAST) guidelines, we compared p16 use and follow-up data before and after implementation of the guidelines.
  
  
  METHODS
  We reviewed all cervical biopsy specimens diagnosed by two pathologists before and after implementation of the LAST guidelines and calculated the rate of and reason for p16 use across all biopsy specimens, high-grade squamous intraepithelial lesion (HSIL) detection, and follow-up.
  
  
  RESULTS
  In total, 1,829 and 1,623 cervical biopsy specimens were reviewed in periods A and B, respectively. Overall p16 use increased from 2.8% to 6.2% (P < .001). Recommendations 2 and 4 increased from 0.16% and 0% of all cervical biopsy specimens in period A to 1.4% and 1.9% in period B, respectively (P < .0001). p16+ HSIL increased from 1.4% to 2.3% (P < .05). The positive predictive value of p16+ HSIL increased from 48% to 76% (P < .05).
  
  
  CONCLUSIONS
  Implementation of the p16 LAST guidelines resulted in a significant increase in p16 use and a significant increase in the positive predictive value of p16+ HSIL.
authors.affiliation: From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and John A. Burns School of Medicine, University of Hawaii, Honolulu. lclinton@hawaii.edu.
authors.forename: Lani K
authors.initials: LK
authors.lastname: Clinton
authors.affiliation: From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and.
authors.forename: Kyle
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and.
authors.forename: Asia
authors.initials: A
authors.lastname: Ayabe
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: James
authors.initials: J
authors.lastname: Davis
authors.affiliation: From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: Pamela
authors.initials: P
authors.lastname: Tauchi-Nishi
authors.affiliation: From the Hawaii Pathologists' Laboratory, Queen's Medical Center, Honolulu, and John A. Burns School of Medicine, University of Hawaii, Honolulu.
authors.forename: David
authors.initials: D
authors.lastname: Shimizu
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000032:analysis*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D030361:Papillomavirus Infections / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D002583:Uterine Cervical Neoplasms / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000821:virology*
chemical_list: D014408:Biomarkers, Tumor; D019941:Cyclin-Dependent Kinase Inhibitor p16
keywords: Cervical pathology; Gynecologic pathology; LAST guidelines; p16