Cervical Cytology
The Pap test : principles of collection and preparation of specimens. Laboratory organisation, screening and reporting cervical smears.
The Pap Test
Collection of specimens
Guidelines on laboratory organisation, processing and screening
Terminology and reporting

Terminology and categories for reporting cervical smears

  • Historical perspective
    It is widely acknowledged that the  criteria and terminology used to interpret and report cervical smears differs country to country. This has led to problems of communication between cytopathologists , cytotechnologists and clinicians and  makes it difficult for epidemiologists to make valid comparisons of the effectiveness of the different cervical screening programmes. The variability in terminology impedes meaningful discussion between laboratories and also affects patient management and the introduction of optimal methods of patient  care.
  • The problem was addressed in 1988, by the National Cancer Institute in the United States who prepared a reporting system for cervical cytology which is known as The Bethesda System (TBS). In1990, the Leonardo da Vinci programme  sponsored the preparation of the Equivalent Terminology Tables which compared the many systems of reporting cervical smears in the European Union with the Bethesda system. See Equivalent Terminology
  • The partners involved in the preparation of  Eurocytology website have opted to use  the terminology proposed in The Bethesda System in view of its world wide application.  Wherever appropriate links to the Equivalent Terminology have been maintained.

The main categories of the Bethesda reporting system (2001) are shown below

2001 Bethesda System
Equivalent Terminology
  • Atypical squamous cells
    • of undetermined significance (ASC-US)
    • cannot exclude HSIL (ASC-H)
  • Borderline nuclear changes
  • Low grade Squamous intraepithelial lesions (LSIL) encompassing: HPV/mild dysplasia/CIN1
  • Mild dysplasia/CIN1  with or without HPV
  • Mild dyskariosis suggestive of CIN1 (with or without HPV)  
  • High grade Squamous intraepithelial lesion (HSIL) encompassing: moderate and severe dysplasia, CIS, CIN2 and CIN3
  • Moderate dysplasia/ CIN2
  • Moderate dyskariosis suggestive of CIN2
  • Severe dysplasia/ CIS/ CIN3
  • Severe dyskariosis suggestive of CIN3
  • With features suspicious for invasion
  • Severe dysplasia/ ?invasive carcinoma
  • Severe dyskariosis/ ?invasive carcinoma
  • Suggests CIN3 but invasive carcinoma not excluded
  • Squamous cell carcinoma
  • Invasive Squamous cell carcinoma
OTHER MALIGNANT NEOPLASMS (specify)

For further information relating to Bethesda follow these links www.bethesda2001.cancer.gov/ 


 

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