The Bethesda System 2014

BETHESDA 2014 for cervico-vaginal screening

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


● 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
● 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

● 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)

     - 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
Details from IARC/WHO

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


Medical Knowledge

    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
    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