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The Bethesda System for Reporting Cervical Cytology

Saturday 14 September 2013

Epithelial cell anomalies according to The Bethesda System

In the US and in many other countries, cytology is reported according to the Bethesda System.

Epithelial cell anomalies according to The Bethesda System

- Atypical squamous cells of undetermined significance ASCUS
- Atypical glandular cells of undetermined significance AGUS
- Low-grade squamous intraepithelial lesion LSIL or LGSIL / Encompasses HPV (koilocytosis), mild dysplasia, CIN-1
- High-grade squamous intraepithelial lesion HSIL or HGSIL / Encompasses moderate and severe dysplasia and carcinoma in situ, CIN2, CIN-3
- Squamous cell carcinoma  
- Endocervical adenocarcinoma  
- Endometrial adenocarcinoma  
- Extrauterine adenocarcinoma  
- Adenocarcinoma, not otherwise specified  
- Other malignant neoplasia  

Nota bene

HSIL or LSIL cytology is the usual trigger to initiate colposcopy and/or diagnostic conization.

The presence of atypical squamous cells of undetermined significance (ASCUS) or atypical glandular cells of undetermined significance (AGUS) cytology, in particular when associated with high-risk human papillomavirus (HPV) and no colposcopic anomaly, also may require the same approach.

Cytologic categories must be distinguished carefully from histologic diagnoses.

Cytology has a high sensitivity for CIN, in general, but a low specificity for its grade.

Regrettably, cytologic and histologic diagnostic terms often are used interchangeably. Cytology tends to underestimate the severity of CIN.

As an example, high-grade (grades 2 and 3) CIN was preceded by HSIL in only 31% of cases in data compiled from 6 publications.

Testing for human papillomavirus: Presence of high-risk HPV (types 16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59), usually detected by Hybrid Capture II test, reinforces the need for histologic diagnosis, even if cytology is reported normal or of undetermined significance.