Table 2C.

Rejected terms for the clinical aspects of echinococcosis.

Word/expression	Definition	Reasons for rejection, references, linguistic clarifications	Comments
* Adventitial (cystectomy), Adjective	Total cystectomy (usually performed without opening the cyst) which uses the dissection space between the adventitial layer and the “normal” liver parenchyma to remove the cyst more easily.	Proposed alternatives to “peri-adventitial” to qualify this surgical technique [35].	The adjectives do not indicate clearly if the resection is performed inside or outside the adventitial layer.
* Sub-adventitial (cystectomy), Adjective			The adjectives, with their definition, were rejected by a majority of voters (median: 0).
Alveococcosis, Noun	Disease related to infection with E. multilocularis.	Historical name for the infection due to E. multilocularis in Russia/Russian language and Russia-related countries.	Not in use in other countries/languages than Russia/Russian
		Not compliant with the recommendations of the World Federation of Parasitologists (WFP), since it is built from the name of a wrong genus.	The only recommended name is “Alveolar echinococcosis (AE)” (see Table 1C).
* Anti-infectious, * Anti-infective, (therapy/treatment/drug),	Drug treatment (usually chemical) of echinococcosis, opposed to or associated with surgery (on the model of infectious diseases therapy).	Although they are commonly used for the treatment of infectious diseases, these adjectives infer prevention as well as (and even rather than) treatment.“Anti-parasitic” is more exact, and more appropriate for parasitic diseases.	The adjectives “anti-infectious” and “anti-infective” were rejected by all voters (median: 10).
Chemotherapy, Noun	Drug treatment (usually chemical) of echinococcosis, opposed to or associated with surgery (on the model of cancer therapy)	The word was used at the first trials of mebendazole/albendazole, for the treatment of echinococcosis, in the 1980s, to stress the “chemical” nature of the treatment and oppose this treatment to surgery which was the only therapeutic option. Has been used commonly thereafter.	Even though echinococcosis shares some particularities with cancer, the word “chemotherapy” has gained a strong cancer-related meaning which may cause confusion, especially when echinococcosis occurs in cancer patients because of the immunosuppressive effect of the anti-cancer chemotherapy. In addition, not all drugs against echinococcosis are chemical (cf. immunotherapy and other biotherapies). It should be abandoned for the use of “anti-parasitic” therapy (or treatment, or drugs). See also Table 1C.
* Closed cystectomy, Expression	Surgical operation which does not include cyst opening before cyst removal (cystectomy).	Widely used by surgeons; however, linguistically incorrect: a cystectomy – which is an intervention – cannot be “closed”, and a cyst is rather “non-opened” than “closed” (the surgeon does not close the cyst, he/she may have it non-opened) [81].	The majority of voters rejected the expression (median: 3).The expression should be replaced by “non-opened cyst (NOC) -cystectomy”.
	Only applies to CE, and for total cystectomy; it is not relevant for AE.		See also Table 1C and Figure 3 and the description of the AORC framework with the definition of its various components in liver CE surgery.
* Daughter hydatid, Expression	Newly formed hydatids inside (and far less frequently outside, if any) the CE cyst in the development of Echinococcus granulosus s.l. Not applicable to E. multilocularis/AE.	Alternative term to “daughter cyst”. Although it fits well with the description of the “hydatid”, as a noun, it is not established by usage.	The term with this definition was rejected by the majority of voters (median: 1).
* Daughter vesicle, Expression	Newly formed hydatids inside (and far less frequently outside, if any) the CE cyst in the development of Echinococcus granulosus s.l. Not applicable to E. multilocularis/AE.	Alternative term to “daughter cyst”. As a literal translation, the use of “vesicle” would fit with the initial description by Dévé (“vésicule fille” in French).	The majority of voters rejected all suggested names for this metacestode structure (median: 3; mean: 4.7, for “daughter vesicle”). The arguments which prevailed to reject “daughter vesicle” and eventually approve the historical expression “daughter cyst” was first the worldwide usage and second the agreement by the participants in the subgroup “Biology and immunology” to restrict the use of “vesicle” to the metacestode of Echinococcus spp. in vitro only, whatever the species.
Echinococcus alveolaris, Expression	Disease related to infection with E. multilocularis.	Name for the infection due to E. multilocularis sometimes used in German-speaking countries.	Mix of the name of the genus and the adjective qualifying the disease (in Latin…).
		Not compliant with the recommendations of the WFP.	The only recommended name is “Alveolar echinococcosis (AE)” (see Table 1C).
Echinococcus cysticus, Expression	Disease related to infection with E. granulosus sensu lato (s.l.).	Name for the infection due to E. granulosus s.l. sometimes used in German-speaking countries	Mix of the name of the genus and the adjective qualifying the disease (in Latin…)
		Not compliant with the recommendations of the WFP.	The only recommended name is “Cystic echinococcosis (CE)” (see Table 1C).
Hydatic, Adjective	Related to Echinococcus spp.	Gallicism for “hydatid”, used as an adjective (“hydatique”, in French).	Should not be used in English.
Hydatid disease, Expression	Disease related to infection with Echinococcus spp.	Commonly used alternative name to designate either all diseases due to Echinococcus spp. or the diseases due to E. granulosus sensu lato. This disease name does not fit with the unified recommendations of the WFP.	This noun should not, in any cases, be used for alveolar echinococcosis or neotropical echinococcosis; it should not be used for E. granulosus s.l. infection in humans either: the only recommended name is “Cystic echinococcosis (CE)” (see Table 1C).
		In addition, usage of this name increases confusion among clinicians and decision makers between the diseases due to E. granulosus sensu lato and E. multilocularis, respectively.	Use of “hydatid” as an adjective should be restricted to infection due to E. granulosus s.l. (see Tables 1B and 1C) in the intermediate hosts.
Hydatid polycystosis, Expression	Cystic (or other) echinococcoses with multiple cysts	Sometimes used in publications. Source of confusion with polycystic (non-parasitic) diseases (see “polycystic”).	The adjective “multi-cystic” is now proposed as a non-specific description of any type of cystic echinococcosis when several/many macroscopic cysts are present and visible at imaging (see Table 1C).
			Use of “hydatid” as an adjective should be restricted to infection due to E. granulosus s.l. (see Table 1C) in the intermediate hosts.
* Hydatidectomy, Noun	Partial cystectomy, including the removal of the germinal and laminated layers of E. granulosus sensu lato cysts after cyst opening	From the definition of “hydatid” (see Table 1B), this noun could replace “partial cystectomy”, with less ambiguity (especially regarding surgeon’s evaluation between “subtotal” and “partial”).	Scientifically correct, but not established by use.
			The term with this definition was rejected by the majority of voters (median: 0).
Hydatidosis, Noun	Disease related to infection with Echinococcus spp.	Commonly used name to designate the diseases due to Echinococcus spp. This disease name does not fit with the recommendations of the WFP	This noun should not, in any cases, be used for alveolar echinococcosis or neotropical echinococcosis; it should not be used for E. granulosus s.l. infection in humans either: the only recommended name is “Cystic echinococcosis (CE)” (see Table 1C).
		In addition, usage of this name increases confusion among clinicians and decision makers between the diseases due to E. granulosus s.l. and E. multilocularis, respectively.
* Open cystectomy, Expression	Surgical operation which includes cyst opening before cyst removal (cystectomy).	Expression widely used by surgeons; however, linguistically incorrect: a cystectomy cannot be “open”, but a cyst may be “opened” (the surgeon does open the cyst) [81].	The majority of voters rejected the expression (median: 3). The expression should be replaced by “non-opened cyst cystectomy” (NOC).
	Only applies to CE; may be at first or second intent; it is not relevant for AE.		See also Table 1C and Figure 3 and the description of the AORC framework with the definition of its various components in liver CE surgery.
Pericystectomy	Removal of a CE cyst which includes all layers of the cyst (including the adventitial layer).	Wrongly used to designate the operation which includes the adventitial layer of the cyst in CE. The prefix “peri” is not useful, since the adventitial layer is part of the cyst; “cystectomy” is thus the appropriate word. Stricto sensu, the “pericyst” is the normal organ parenchyma that surrounds the cyst (see Figs. 2A–2C) [68].	See Table 1C for alternative wording regarding surgery of CE.
			The only noun recommended is “cystectomy”.
			See also Figure 3 and the description of the AORC framework with the definition of its various components in liver CE surgery.
Polycystic echinococcosis, Expression	Disease related to infection with E. vogeli (stressing the multicystic type/presentation of E. vogeli infection).	The expression is sometimes wrongly used in medical publication to designate diseases due both to E. vogeli, which is most often polycystic/multicystic and E. oligarthra, which usually presents with single cysts similar to those of CE, in humans and in animal intermediate hosts [11, 35] but may also be multicystic or even microcystic (AE-like) [69].	The only recommended name for the diseases due to E. vogeli and E. oligarthra is “Neotropical echinococcosis (NE)” (see Table 1C).
		In addition, “polycystic” may cause confusion between the disease due to E. vogeli and “polycystic” clinical types of E. granulosus and E. multilocularis infections. The adjective “polycystic” is widely used to designate a genetic non-parasitic disease of the liver and kidney, adding to the confusion.	The adjective “multicystic” is now proposed as a non-specific description of any type of cystic echinococcosis when several/many macroscopic cysts are present and visible at imaging (see Table 1C).
Polycystic, Adjective	Constituted of several cysts (used to qualify the imaging and operative aspect of various types of echinococcosis).	The adjective “polycystic” is not specific to echinococcosis; “polycystic” is widely used to qualify a genetic non-parasitic disease of the liver and kidney; in addition, it has been used to distinctly qualify the disease due to E. vogeli (see below).	The adjective “multicystic” is now proposed as a non-specific description of any type of cystic echinococcosis when several/many macroscopic cysts are present and visible at imaging (see Table 1C).
Protoscolicide, Noun; Protoscolicidal, Adjective	Compound (natural or chemical) which is able to kill the protoscolex.	Synonym for protoscolecide. The protoscolex is the final stage of the metacestode of Echinococcus spp, able to produce a scolex then an adult form of the parasite in the definitive host, or to reproduce a metacestode in the intermediate host. From the ancient Greek “σκὠλεξ”-scolex (worm), genitive: σκὠλεκος-scolecos, and not scolicos; plural σκὠλεκες, scoleces, and not scolices), with the prefix “πρῶτος”-protos (first/before), and the Latin suffix –“-cide”, from “caedere” (to kill).	Should be abandoned for “protoscolecide” (see Table 1C); protoscolecides (protoscolecidal agents) are used to kill the protoscoleces and/or prevent secondary cysts after surgery.
** Relapse, Noun	Any type of echinococcosis lesions that appeared after the implementation of any type of treatment.	The definition is vague and covers several types of lesion appearing after attempts of treatment. More precise definitions of lesions observed in this situation should be used.	Should be abandoned for specific terms/expressions covering the various situations encountered by clinicians (see in Table 1C the definitions of “new CE cyst”, “reactivation”, “recurrence”, and “secondary echinococcosis”).
Scolecide, Noun; Scolecidal, Adjective	Compound (natural or chemical) that is able to kill the scolex.	The scolex is the head of the adult form of Echinococcus spp. From the ancient Greek “σκὠλεξ”, genitive: σκὠλεκος-scolecos; plural ςσκὠλεκες, scoleces). Such compounds are used to kill protoscoleces, produced by the metacestode in intermediate hosts, not scoleces in the definitive hosts. Usage of “scolecide” is thus scientifically inexact (killing concerns the protoscoleces, not the scoleces).	Should be abandoned for “protoscolecide” (see Table 1C).
Scolicide, Noun; Scolicidal, Adjective	Compound (natural or chemical) that is able to kill the scolex.	Synonym for scolecide. The common usage of “scolicide” is both scientifically inexact (killing concerns the protoscoleces, not the scoleces) and etymologically wrong (see also “scolecide” and “protoscolicide”).	Should be abandoned for “protoscolecide/protoscolecidal” (see Table 1C).

^*Agreement to reject the term obtained at the second stage of the consultation (the participants in the Consultation and Rating Group had to rate their approval or rejection of the words/expressions independently on a scale from 0 to 10; whenever relevant, the median of the votes is given in the “Comments” column).

^**Agreement to reject a term that was not selected at the first stage of consultation; the agreement was obtained at the second stage after further discussion between experts or after recommendation by the RRG.