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Bethesda System 2001 for Cervicovaginal Cytology reporting


Marilin Rosa, M.D.

Topic Completed: 1 August 2010

Revised: 20 December 2018, last major update August 2010

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

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Marilin Rosa, M.D.
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Table of Contents
Definition / general | Additional references
Cite this page: Rosa M. Bethesda System 2001 for Cervicovaginal Cytology reporting. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/cervixcytologybethesda.html. Accessed October 18th, 2019.
Definition / general
  • 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 nonneoplastic 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
      • 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 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
      • Glandular cell
        • 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)
      • Other malignant neoplasms (Specify)
        • 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
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