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.

Farlex Partner Medical Dictionary © Farlex 2012
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
Segen's Medical Dictionary. © 2012 Farlex, Inc. All rights reserved.

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]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

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.
Medical Eponyms © Farlex 2012
References in periodicals archive ?
Atypical Squamous Cells of Undetermined Significance: Bethesda Classification and Association with Human Papillomavirus.
Table 1 shows the distribution of the thyroid cytology findings according to the Bethesda classification. In total, we found 113 malignancies.
One should emphasize, however, that one of the four parts of the new Bethesda classification specifies such inflammatory lesions as: Trichomonas vaginalis, Candida, Actinomyces, Chlamydia, cellular changes consistent with HSV infection, and changes of bacterial flora.
Pap Smear Finding according to Bethesda Classification Diagnosis Number of Patients Percentage (%) Inadequate 35 5 NILM Normal 107 15.3 Non-specific inflammation 511 73 Bacterial vaginosis 29 4.1 Trichomoniasis 13 1.9 ASCUS 2 0.3 LSIL 2 0.3 HSIL 1 0.1 Carcinoma 0 0 Total 700 100
Noninvasive EFVPTC nodules typically yielded indeterminate cytology results on fine needle aspiration biopsy (73% Bethesda Classification 3 or 4) with 12 of the 13 (92%) who underwent Afirma GEC testing classified as "suspicious." Although we did not routinely perform mutational testing at our center from 1/2013 to 9/2016, two of our patients were found at outside institutions to have DNA alterations including a PAX8/PPAR gamma translocation and a low level NRAS mutation affecting 8% of thyrocytes, corresponding to an allelic frequency of 4%.
The intention was to develop a system of classification of thyroid FNA similar in scope to the Bethesda Classification for gynecologic cervical cytology.
The target population includes categories III (atypia of indeterminate significance or follicular lesion of indeterminate significance (AUS / FLUS)) and IV (follicular neoplasm or suspicion of follicular neoplasm (FN / SFN)) of the Bethesda classification. The trial received a favourable opinion from the Ethics Committee in July and authorisation from ANSM (French health authority) in August.
The purpose of this study was to evaluate Bethesda Classification for reporting thyroid by recording interobserver reproducibility.
Pap results were read in Sao Paulo using traditional classification methods, then again in Montreal using the Bethesda classification system.
In the Bethesda classification system, abnormal Paps are labeled LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), or ASCUS (atypical squamous cells of undetermined significance).
The concordant rate between initial cytology and second expert opinions was 55% (11/20 nodules), reflecting an inherent limitation to the reproducibility of interpreting any cytology specimen as demonstrated by a blinded prospective evaluation of interobserver concordance using Bethesda classification [24].
Wang et al propose a 6-tier cytopathologic classification system, similar to the Bethesda classification for thyroid fine needle aspiration, for fine-needle aspiration biopsy of salivary gland lesions.