Bethesda System 2001 for Cervicovaginal Cytology reporting

Cervix
Cytology
Bethesda System 2001 for Cervicovaginal Cytology reporting

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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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 January 28th, 2020.

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

Details from IARC/WHO