The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses : Definitions, Criteria, and Explanatory Notes for Terminology and Specimen Adequacy

THE BETHESDA SYSTEM FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES was developed at a National Cancer Institute sponsored workshop in December 1988 to provide uniform diagnostic terminology that would facilitate communication between the laboratory and the clinician. The format of The Bethesda System report includes a descriptive diagnosis and an evaluation of specimen adequacy. The Bethesda System we designed to be flexible in order that it could evolve in response to changing needs in cervical cancer screening as well as to advances in the field of cervical pathology. Subsequently, a second workshop was held in April 1991 to evaluate the impact of The Bethesda System in actual practice and to amend and modify it where needed. One of the major recommendations of this second meeting was that precise criteria should be formulated for both the diagnositic terms and for the descriptors of specimen adequacy. That is the intended purpose of this report. Specimen Adequacy: Definitions, Criteria And Explanatory Notes -- Background -- Patient And Specimen Identification -- Pertinent Clinical Information -- Technical Interpretability -- Cellular Composition And Sampling Of The Transformation Zone -- Definitions And Criteria For Specimen Adequacy -- Descriptive Diagnoses: Definitions, Criteria And Explanatory Notes -- Benign Cellular Changes -- Infection -- Trichomonas Vaginalis -- Fungal Organisms Morphologically Consistent With Candida Spp. -- Predominance Of Cocobacilli Consistent With Shift In Vaginal Flora -- Bacteria Morphologically Consistent With Actinomyces Spp. -- Cellular Changes Associated With Herpes Simplex Virus -- Other -- Reactive Changes -- Reactive Cellular Changes Associated With: Inflammation (includes Typical Repair); Atrophy With Inflammation (atrophic Vaginitis); Radiation; Intrauterine Contraceptive Device (iud); Other -- Epithelial Cell Abnormalities -- Squamous Cell -- Atypical Squamous Cells Of Undetermined Significance (ascus): Qualify. (cont) Low-grade Squamous Intraepithelial Lesion (lsil) Encompassing: Human Papillomavirus (hpv)/mild Dysplasia/cervical Intraepithelial Neoplasia (cin) 1 -- High-grade Squamous Intraepithelial Lesion (hsil) Encompassing: Moderate Dysplasia, Severe Dysplasia, And Carcinoma In Situ/cin 2 And Cin 3 -- Squamous Cell Carcinoma -- Glandular Cell -- Endometrial Cells, Cytologically Benign, In A Postmenopausal Woman -- Atypical Glandular Cells Of Undetermined Significance (agus): Qualify -- Endocervical Adenocarcinoma -- Endometrial Adenocarcinoma -- Extrauterine Adenocarcinoma -- Adenocarcinoma, Nos -- Other Malignant Neoplasms. Robert Kurman ... [et Al.]. Includes Bibliographical References And Index. The Bethesda System (TBS) for Reporting CervicaVVaginal Cytologic Diagnoses was developed at a National Cancer Institute (NCI)-sponsored workshop in December 1988 to provide uniform diagnostic terminology that would facilitate communication between the laboratory and the clinician. The format ofTBS report includes a descriptive diagnosis and an evaluation of specimen adequacy. TBS was designed to be flexible so that it could evolve in response to changing needs in cervical cancer screening as well as to advances in the field of cervical pathology. Subsequently, a second workshop was held in April 1991 to evaluate the impact of TBS in actual practice and to amend and modify it where needed. One of the major recommendations of this second meeting was that precise criteria should be formulated for both the diagnostic terms and for the descriptors of specimen adequacy. That is the intended purpose of this monograph. The classification used in TBS is not a histogenetic one, but rather a nomenclature designed to facilitate categorization and reporting of cyto­ logic diagnoses. The overall diagnosis, as in the World Health Organiza­ tion (WHO) system, is based on the most abnormal cells present regardless of their number. In addition, it should be noted that the site of origin of an abnormality detected in a cervicaVvaginal cytologic sample cannot always be specified because morphologically identical tumors may arise in the vagina, cervix, endometrium, or ovary. The Bethesda System Was Developed At A National Cancer Institute Sponsored Workshop In December 1988 To Provide Uniform Diagnostic Terminology That Would Facilitate Communication Between The Laboratory And The Clinician. The Format Of This Report Includes A Descriptive Diagnosis And An Evaluation Of Specimen Adequacy. A Second Workshop Was Held In April 1991 To Evaluate The Impact Of The Bethesda System In Actual Practice And To Amend And Modify It Where Needed. One Of The Major Recommendations Of This Second Meeting Was That Precise Criteria Should Be Formulated For Both The Diagnostic Terms And For The Descriptors Of Specimen Adequacy. That Is The Intended Purpose Of This Report. Front Matter....Pages i-1 Specimen Adequacy Definitions, Criteria, and Explanatory Notes....Pages 3-8 Descriptive Diagnoses Definitions, Criteria, and Explanatory Notes....Pages 9-81