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 ?
Bethesda system was able to make the documentation of PAP screening complete, organized and uniform.
The Bethesda System for Reporting Cervical Cytology: A Historical Perspective.
McHenry, "Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda System for Reporting Thyroid Cytopathology," Surgery, vol.
infection was diagnosed only in 9.3% of women through cytological smear, according to the Bethesda system.
In the present study, out of 75 cases of PTC, there were 6 (8%) nondiagnostic cases and 3 (4%) benign cases as per the Bethesda system of reporting thyroid cytopathology.
Reproducibility of 'The Bethesda System for reporting Thyroid Cytopathology': A MultiCenter Study with Review of the Literature.
Bethesda system for the classification of thyroid cytopathology Bethesda Cytopathologic Approximate Malignancy category category expected frequency rate I Non-diagnostic/Inadequate 5-11% 1-4% II Benign 55-74% 0-3% III Atypia/follicular lesion of 5-15% 5-15% undetermined significance IV Follicular neoplasm/ 2-25% 15-30% suspicious for FN V Suspicious for malignancy 1-6% 60-75% VI Malignant 2-5% 97-99% Bethesda Suggested treatment (Prior to category availability of molecular testing) I Repeat FNA II US follow-up III Repeat FNA or US follow-up or Lobectomy IV Lobectomy V Lobectomy or Thyroidectomy VI Near-total thyroidectomy FNA: Fine-needle aspiration, FN: Follicular neoplasm, US: Ultrasonographic
To the best of our knowledge, it is the first study done in Pakistan in which interobserver agreement for Bethesda System was analysed.
TABLE 1: Fine needle aspiration biopsy diagnostic categories, adapted from Cibas and Ali (The Bethesda System for Thyroid Cytopathology) [6].
The cervical epithelial cell abnormalities originate in the squamous or glandular cells and in the Pap smears range from atypia and mild-to-severe dyskaryosis to invasive cancer.11 The significance as well as consequence of these cytological diagnoses have been extensively elaborated in the 2001 Bethesda System.12 The category of Atypical Squamous Cells (ASC) includes ASC-US (ASC of undetermined significance) and ASC-H (ASC cannot exclude High Grade Squamous Intraepithelial Lesion, HSIL).
The material obtained is graded according to the Bethesda System like a cervical sample.