Evolution of Bethesda System for Re port ing Cervical Cancer Cytological Screening

Abstract

Evolution of Bethesda System for Reporting Cervical Cancer Cytological Screening

Sumarin Pratumkaew BSc (Biology)*

Siriwan Tangjitgamol MD**

Apichote Khumsangmeun BSc (Biology)*

* Department of Anatomical Pathology

** Department of Obstetrics and Gynecology

Faculty of Medicine Vajira Hospital, University of Bangkok Metropolis

The Bethesda system (TBS) was introduced in 1988 with an intention to replace Papanicoloau, dysplasia, cervical intraepithelial neoplasia systems. This system covers an adequacy of specimen and introduces a new

classification of abnormal cells. In 1991, TBS added detail on the adequacy of specimen and included a category of “satisfactory but limited by.” In 2001, TBS included specimen type while the category “satisfactory but limited by” was eliminated, and replaced “within normal limits” with the term “negative for intraepithelial lesion or malignancy.” The category of atypical squamous cells (ASC) divided into qualifiers ASC of undetermined significance (ASC-US) and cannot exclude HSIL (ASC-H) and added HSIL (high grade squamous intraepithelial lesion) with features suspicious for invasion. The term “atypical glandular cells (AGC) was divided into AGC, NOS (not otherwise specified) and AGC favor neoplastic, while adenocarcinoma in situ (AIS) was separated from AGC categories. It also included management guidelines with cervical cytological abnormalities.

Keywords: Papanicolaou, dysplasia, cervical intraepithelial neoplasia, the Bethesda system

Vajira Med J 2010 ; 54 : 395 - 404