The Bethesda System 2014

BETHESDA 2014 for cervico-vaginal screening

Cervix-Cytology
Bethesda System 2001 for Cervicovaginal Cytology reporting
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.

Definition
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● Based on workshop held in April/May 2001 at National Cancer Institute (
JAMA 2002;287:2114)
● By 2003, was implemented by 85% of labs participating in College of American Pathologists’ Interlaboratory Comparison Program in Cervicovaginal Cytology (
Arch Pathol Lab Med 2004;128:1224)
Changes from Bethesda 1991
● Specimen type:
Indicate conventional smear (Pap smear), liquid based preparation or other preparation (describe)

● Specimen adequacy:
Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and all other quality indicators, such as partially obscuring blood, inflammation, etc.)

Assessment of specimen adequacy (satisfactory and unsatisfactory):
1 - Adequate number of squamous cells (conventional smear should have 8,000-12,000 cells, liquid-based preparation should have 5,000 cells)
2 -The presence or absence of endocervical cells should be reported; an adequate number of endocervical cells (at least 10 well-preserved endocervical or metaplastic cells, singly or in clusters) confirms sampling of transition zone
3 - Specimen with more than 75% of cells obscured by inflammation and bacteria is unsatisfactory (assuming that no abnormal cells are present)

- Unsatisfactory for evaluation (indicate reason)
- Specimen rejected/not processed (indicate reason)
- Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality (indicate reason)

Interpretation/result Negative for Intraepithelial Lesion or Malignancy (NILM)
- Organisms
Trichomonas vaginalis
● Fungal organisms morphologically consistent with Candida species
● Shift in flora suggestive of bacterial vaginosis
● Bacteria morphologically consistent with Actinomyces species
● Cellular changes associated with Herpes simplex virus

- Other non-neoplastic findings (optional to report, list is not inclusive)
● Reactive cellular changes associated with:
     - inflammation (includes typical repair)
     - radiation
     - Intrauterine contraceptive device (IUD)
● Glandular cells status post hysterectomy
● Atrophy

- Other
● Endometrial cells (in a woman older than or equal to 40 years of age; specify if “negative for squamous intraepithelial lesion”)

Epithelial Cell Abnormalities
SQUAMOUS CELL
● Atypical squamous cells
      - of undetermined significance (ASC-US)
      - cannot exclude HSIL (ASC-H)
● Low grade squamous intraepithelial lesion (LSIL)
      - encompassing HPV/mild dysplasia/CIN I
● High grade squamous intraepithelial lesion (HSIL)
      - encompassing: moderate and severe dysplasia/CIN2/CIN3/CIS
      - with features suspicious for invasion (if invasion suspected)
● Squamous cell carcinoma

GLANDULAR CELL
● Atypical
      - endocervical cells (NOS or specify in comment)
      - endometrial cells (NOS or specify in comment)
      - glandular cells (NOS or specify in comment)
● Atypical
      - endocervical cells, favor neoplastic
      - glandular cells, favor neoplastic
● Endocervical Adenocarcinoma in situ
● Adenocarcinoma
      - endocervical
      - endometrial
      - extrauterine
      - not otherwise specified (NOS)

● OTHER MALIGNANT NEOPLASMS (Specify)
     - ANCILLARY TESTING: Describe briefly the test method(s) and report the result so that it is easily understood by the clinician
     - AUTOMATED REVIEW: If case is examined by automated device, specify the device and result
     - EDUCATIONAL NOTES/SUGGESTIONS: If provided, should be concise and consistent with clinical guidelines published by professional organizations

Additional references
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Details from IARC/WHO

End of Cervix-cytology > Normal cells / non-neoplastic findings > Bethesda System 2001 for Cervicovaginal Cytology reporting

2014

Medical Knowledge
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    1. Know the basic outline for reporting cervical cytology according the 2001 Bethesda System
    1. Recognize the adequacy or inadequacy criteria for interpretation of a Pap test
    1. Recognize the differences of adequacy and interpretation when dealing with a conventional smear as opposed to a liquid based pap test
    1. Understand the general diagnostic categories
    1. Recognize when reporting additional information is of value to the clinician and patient
      • Ancillary testing
      • Automated review
      • Educational notes and suggestions
Practice Based Learning
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    1. Understand the minimum quality and quantity of material present to evaluate in order to consider a specimen as adequate
    1. Understand the various situations, other than quantity of cells present to evaluate, that would render a specimen unsatisfactory or inadequate for evaluation
      • Obscuring factors
      • Specimen not labeled
      • Broken slides
    1. Understand the use of explanatory notes to convey important information that might not be explicit in the standard layout of a report