Bethesda system


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Be·thes·da sys·tem

a system for reporting cervical or vaginal cytologic findings and diagnoses.
[Bethesda, Maryland, site of NIH]

In the 1940s George Papanicolaou divided cytologic findings on stained cervical smears into five classes, ranging from I (normal) to V (carcinoma). Classes II through IV represented increasing degrees of premalignant squamous cellular atypia. Later workers modified the system by introducing the terms dysplasia (mild, moderate, severe) and cervical intraepithelial neoplasia (CIN) (grades 1 through 3). Papanicolaou (Pap) smear findings reported according to this nomenclature showed poor reproducibility between observers and even between separate readings by the same observer. In addition, there was little correlation between diagnostic categories and treatment options. In 1988 the National Cancer Institute sponsored a workshop in Bethesda, Maryland, to establish a more useful system. The Bethesda system was first used in 1991 and soon became standard throughout the world. Several revisions were made in 2001. The standard format for reporting cervical cytology findings according to the Bethesda system comprises three elements: 1. a statement of the adequacy of the specimen for examination (satisfactory or unsatisfactory); 2. general categorization (negative for intraepithelial lesion or malignancy; epithelial cell abnormality; or other); and 3. descriptive diagnosis, elaborating on the general categorization and including mention of all significant abnormalities, as well as of the patients hormonal status (when vaginal cells are present in the smear). A specimen that is negative for an intraepithelial lesion or malignancy may be reported as showing evidence of pathogenic organisms (for example, Trichomonas, Candida, cellular changes consistent with herpes simplex virus infection) or of nonneoplastic tissue changes (for example, inflammation, atrophy). Epithelial cell abnormalities may involve either squamous or glandular cells. The system replaces numeric designations with descriptive diagnoses of cellular changes. Squamous cell changes formerly called mild dysplasia or CIN 1, including cellular atypia characteristic of human Papillomavirus (HPV) infection, are designated low-grade squamous intraepithelial lesion (LSIL). The category of high-grade squamous intraepithelial lesion (HSIL) encompasses what were formerly called moderate and severe dysplasia or CIN 2 and CIN 3. Cytologic changes that suggest a squamous intraepithelial lesion but are quantitatively or qualitatively insufficient for a definitive interpretation are divided into atypical squamous cells of undetermined significance (ASC-US) and those with changes suggestive but not diagnostic of high-grade squamous cell intraepithelial lesions (ASC-H). It is estimated that 50 million Pap smears are performed annually in the U.S., of which 5-10% are reported as showing either ASC-US or ASC-H. In women with ASC-US, testing for high-risk HPV types by DNA probe is more sensitive than repeat thin-layer Pap smear in detecting high-grade lesions or cancer. The finding of ASC-H, LSIL, or HSIL is an indication for colposcopy and directed biopsy.

A system for reporting results from pap smears, which provides a uniform format for cervical and vaginal cytologic specimens, classifies noninvasive lesions and standardizes the lexicon for cervical/vaginal cytology reports, providing clinically relevant information

Be·thes·da sys·tem

, Bethesda classification (bĕ-thez'dă sis'tĕm, klas'i-fi-kā'shŭn)
A comprehensive system for reporting findings on cervical Papanicolaou smears; includes observations on the adequacy of the specimen, benign cellular changes (inflammation, infection), changes in squamous or glandular epithelial cells reflecting atypia or malignancy, and hormonal status.
[Bethesda, Maryland, site of NIH]

Bethesda,

city in Maryland.
Bethesda system - classification system for cervical Papanicolaou smears; originated in Bethesda, Maryland.
Bethesda unit - measure of inhibitor activity; originated in Bethesda, Maryland.
References in periodicals archive ?
Malignancy risk for fine-needle aspiration of thyroid lesions according to the Bethesda system for reporting thyroid cytopathology.
The revised Bethesda system is not expected to be widely adopted immediately, because most laboratories will take the basic document and make their own adaptations.
Minor modifications were incorporated into the 1991 Bethesda System which streamlined the terminology (see Table 2).
The 2001 Bethesda system sought to eliminate the confusion around an ASC-US diagnosis, by better defining criteria, encouraging downgrading to negative for intraepithelial lesion and malignancy (NILM) when possible, and introducing a new atypical category--atypical squamous cells of a high-grade squamous intraepithelial lesion cannot be ruled out (ASC-H).
There was general agreement that even though the Bethesda system is technically meant only to report cervical cancer and its precursors, inclusion of such additional information is important for ethical and medicolegal reasons and to satisfy CLIA regulations.
When our reference laboratory began using the Bethesda system of reporting, the implications immediately became evident.
The interpretation of atrophic vaginitis from Papanicolaou (Pap) tests is seemingly subjective, despite descriptive terminology criteria published by the Bethesda System for Reporting Cervical Cytology, (1) as evidenced by the historically poor performance on these slides in the College of American Pathologists (CAP) Interlaboratory Comparison Program in Gynecologic Cytopathology (PAP Education).
The Bethesda System suggests another guideline: A lab's ASCUS rate should be no more than two to three times higher than the cumulative rate of low-grade SIL plus high-grade SIL diagnoses.
The ThinPrep Imaging System (Imager) is a device that uses computer imaging technology to assist in primary cervical cancer screening of ThinPrep(R) Pap Test slides for the presence of atypical cells, cervical neoplasia, including its precursor lesions, and carcinoma, as well as all other cytologic criteria as defined by The Bethesda System 2001.
For example, a common recommendation in the Bethesda system is to perform a repeat aspiration for patients who receive a diagnosis of atypical follicular cells.
The Cytyc Corporation ThinPrep(R) Imaging System (Imager) is a device that uses computer imaging technology to assist a cytotechnologist performing primary cervical cancer screening of ThinPrep(R) Pap Test slides for the presence of atypical cells, cervical neoplasia, including its precursor lesions, and carcinoma, as well as all other cytologic criteria as defined by The Bethesda System 2001.
During the past few decades, the Bethesda system have begun to introduce a simplified and uniform classification scheme for reporting gynecologic, breast, and thyroid cytology by defining each diagnostic category in an attempt to facilitate follow-up decisions by our clinical colleagues.