The Bethesda System
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In December 1988, the National Cancer Institute held a workshop in Bethesda, Maryland, to address the standardization of cervical and vaginal cytology reports to facilitate peer review and quality assurance. From this workshop, the Bethesda System for cytologic reporting was developed.
The Bethesda System report includes three general categories:
1. Adequacy of the specimen
2. General categorization
3. Descriptive diagnoses
Adequacy of the Specimen
Satisfactory for Evaluation
A statement that the specimen is “satisfactory” indicates that it includes all of the following: appropriate labeling and identification, relevant clinical information, adequate numbers of interpretable squamous epithelial cells, and an adequate endocervical or transformation zone component. Well-preserved and well-visualized squamous cells should be spread over more than 10% of the slide surface.
Satisfactory for Evaluation but Limited by
Cancer treatment
The clarification “satisfactory for evaluation but limited by” indicates that any of the following apply: lack of pertinent clinical information accompanying the slide or inability to interpret more than 50% of the epithelial cells due to obscuring blood, inflammation, poor fixation, air drying, or contaminant. There should be at least two clusters of well-preserved endocervical or squamous metaplas-tic cells, with each cluster composed of at least five cells. The report indicates that the specimen can be interpreted; however, the interpretation is compromised. Determination of specimen adequacy is ultimately the responsibility of the clinician who correlates the findings of the cytology report with the clinical status of the patient. The absence of an endocervical or transformation zone component does not necessarily require a repeat Pap test. Data from the literature are thus far inconclusive with regard to the endocervical component as a measure of adequacy. Short-term longitudinal studies have demonstrated no increase in the frequency of subsequent squamous lesions among women whose initial specimens lacked endocervical cells.
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