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BETHESDA SYSTEM
NCI The
Bethesda System 2001
2001 Terminology
The Bethesda system (TBS) of classifying Pap tests was developed
by the United States National Cancer Institute (NCI) to provide more detailed
information about Pap test results. The system increases the communication between
the health professional who does the Pap test and the laboratory specialist
(cytologist) who examines the cervical cells. It provides information about
the quality of the cell sample and the types of cell changes found.
SPECIMEN TYPE: Indicate conventional smear
(Pap smear) vs. liquid based vs. other
SPECIMEN ADEQUACY
- Satisfactory for evaluation (describe presence or absence
of endocervical/transformation zone component and any other quality indicators,
e.g., partially obscuring blood, inflammation, etc.)
- Unsatisfactory for evaluation ... (specify reason)
- Specimen rejected/not processed (specify reason)
- Specimen processed and examined, but unsatisfactory for
evaluation of epithelial abnormality because of (specify reason)
GENERAL CATEGORIZATION (optional)
- Negative for Intraepithelial Lesion or Malignancy
- Epithelial Cell Abnormality: See Interpretation/Result
(specify ‘squamous’ or ‘glandular’ as appropriate)
- Other: See Interpretation/Result (e.g. endometrial cells
in a woman 40 years of age)
AUTOMATED REVIEW
If case examined by automated device, specify
device and result.
ANCILLARY TESTING
Provide a brief description of the test methods
and report the result so that the clinician easily understands it.
INTERPRETATION/RESULT
NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY
(when there is no cellular evidence of neoplasia, state this in the General
Categorization above and/or in the Interpretation/Result section of the report,
whether or not there are organisms or other non-neoplastic findings).
ORGANISMS:
- Trichomonas vaginalis
- Fungal organisms morphologically consistent with Candida
spp.
- Shift in flora suggestive of bacterial vaginosis
- Bacteria morphologically consistent with Actinomyces
spp.
- Cellular changes consistent with Herpes simplex virus
OTHER NON NEOPLASTIC FINDINGS (Optional to
report; list 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 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 1
- High grade squamous intraepithelial lesion (HSIL)
encompassing: moderate and severe dysplasia, CIS/CIN 2 and CIN 3
- With features suspicious for invasion (if invasion
is suspected)
- Squamous cell carcinoma
GLANDULAR CELL
- Atypical
- endocervical cells (NOS or specify in comments)
- endometrial cells (NOS or specify in comments)
- glandular cells (NOS or specify in comments)
- 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)
EDUCATIONAL NOTES AND SUGGESTIONS (optional)
OTHER USEFUL LINKS ON THE NEW BETHESDA
RULES
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