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Cytopathology of the uterine cervix - digital atlas

The Bethesda 2001 system  Rechercher The Bethesda 2001 system

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Differences when compared with Bethesda 1991:
Now introduced:
  • The type of specimen taken, the notion of an automated examination and carrying out complimentary techniques (HPV testing)
  • The “descriptive diagnosis” category becomes “interpretation/results”
  • conventional smear (Pap smear)
  • vs. liquid-based preparation
  • vs. other.
The diffusion of liquid based preparation techniques (or smear) (cell suspension) gives good reason for this information to be in the report.
      Satisfactory for evaluation
      • (describe presence or absence of endocervical/transformation zone component and any other quality indicators, e.g., partially obscuring blood, inflammation, etc.)
      Unsatisfactory for evaluation …(specify reason)
      • Specimen rejected/not processed (specify reason)
      • Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)
      Compared with Bethesda 1991 classification, the category ‘Satisfactory, but limited by …’ has been removed. In addition and by definition, each preparation with abnormal cells (ASC-US, AGC or more ), is classified as satisfactory. Cellularity criteria are given. If more than 75% of cells are obscured by blood or inflammation, the specimen is unsatisfactory.
          GENERAL CATEGORIZATION (optional)
          Negative for Intraepithelial Lesion or Malignancy

          • See Interpretation/result (e.g., endometrial cells in a woman >= 40 years of age)
          Epithelial Cell Abnormality:
          • See Interpretation/result
          • (specify ‘squamous’ or ‘glandular’ as appropriate)
          The 1991 expression ‘general diagnosis’ has now become ‘general classification’, and is optional for the report.
              Negative for intraepithelial lesion or malignancy
              • Organisms
              • Other non neoplastic findings (optional to report; list not inclusive)
                • Other:
                  • Endometrial cells (in a woman >= 40 years of age) (Specify if ‘negative for squamous intraepithelial lesion’)
                  • Epithelial cell abnormalities:
                    • Squamous cell
                    • Glandular cell
                    Other malignant neoplasms: (specify)
                ‘Benign cell modifications’ category of 1991 TBS is grouped with the ‘negative for intraepithelial lesion of malignancy’.
                    INTERPRETATION/RESULT (2)
                    Negative for intraepithelial lesion or malignancy(when there is no cellular evidence of neoplasia, state this in the General Categorization above and/or in the Interpretation/Result section of the report, whether or not there are organisms or other non-neoplastic findings).
                    • Organisms:
                      • Trichomonas vaginalis
                      • Fungal organisms morphologically consistent with Candida spp
                      • Shift in flora suggestive of bacterial vaginosis
                      • Bacteria morphologically consistent with Actinomyces spp.
                      • Cellular changes consistent with Herpes simplex virus
                    • Other non neoplastic findings (Optional to report; list not inclusive):
                      • Reactive cellular changes associated with
                        • inflammation (includes typical repair)
                        • radiation
                        • intrauterine contraceptive device (IUD)
                      • Glandular cells status post hysterectomy
                      • Atrophy
                    • Endometrial cells (in a woman >= 40 years of age)(Specify if ‘negative for squamous intraepithelial lesion’)
                    ‘Benign cell modifications’ category is grouped with the ‘negative for intraepithelial lesion or malignancy lesion’ category. When endometrial cells are present in women over 40 years, the absence of intraepithelial lesions or malignancy lesions should be stated.
                        INTERPRETATION/RESULT (3)
                        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 1)
                        • High grade squamous intraepithelial lesion (HSIL) (encompassing: moderate and severe dysplasia, CIS, CIN 2 and CIN 3)
                          - with features suspicious for invasion (if invasion is suspected)
                        • Squamous cell carcinoma
                        The most important modification is in the ASC category with a more precise definition of the criteria, the exclusion of ‘probably reactive ASC-US’ and individualisation of ASC-H. One shoud remember that this category of ASC-H corresponds to the interpretation of a whole preparation and not of one cell.
                            INTERPRETATION/RESULT (4)
                            Epithelial cell abnormalities
                            Glandular cell
                            • Atypical
                              • endocervical cells (not otherwise specified (NOS) or specify in comments)
                              • endometrial cells (NOS or specify in comments)
                              • glandular cells (NOS or specify in comments)
                            • Atypical
                              • endocervical cells, favor neoplastic
                              • glandular cells, favor neoplastic
                            • Endocervical adenocarcinoma in situ
                            • Adenocarcinoma:
                              • endocervical
                              • endometrial
                              • extrauterine
                              • not otherwise specified (NOS)
                            The major modifications are the individualisation of endocervical adenocarcinoma in situ due to well-defined cytology criteria, and the disappearance of AGC of undetermined significance (AGUS).
                                INTERPRETATION/RESULT (5)
                                OTHER MALIGNANT NEOPLASMS: (specify)
                                  In addition to common types of squamous cell carcinomas cancers, as well as secondary and metastatic tumours may be observed.
                                      ANCILLARY TESTING
                                      Provide a brief description of the test method(s) and report the result so that it is easily understood by the clinician.
                                        The HPV test method should be mentioned (PCR or hybrid capture). And, whenever possible, these results should be included in the report.
                                            AUTOMATED REVIEW
                                            If case examined by automated device, specify device and result.
                                              Mention which system has been used, whether the analysis was carried out correctly and whether the glass slides were reviewed has to be mentionned in the report.
                                                  EDUCATIONAL NOTES AND SUGGESTIONS (optional)
                                                  Suggestions should be concise and consistent with clinical follow-up guidelines published by professional organizations (references to relevant publications may be included).
                                                    These references come from consensus conferences and/or recommendations from knowledgeable or official organisations (e.g., ANAES in France). These notes may, for example, show how to repeat the collection of a new specimen if the first one was not satisfactory, how to individualise the patients needing specific follow-up and the required investigations.
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