nicolaou suggesting the following groups: Class I, ab-REPORTING SYSTEMS sence of atypical or abnormal cells; Class II, atypical The idea of diagnosing cancer through the recovery cytology but no evidence of malignancy; Class III, cytoland identification of exfoliated cancer cells in body fluids ogy suggestive of, but not conclusive for, malignancy; and secretions dates back to the nineteenth century. The Class IV, cytology strongly suggestive of malignancy; "Father of Exfoliative Cytology," George Papanicolaou, and Class V, cytology conclusive for malignancy. Alwas born in Coumi, Greece, received his M.D. degree though this remained the basis for classification for many from the University of Athens (1904) and his Ph.D. degree years, there were often simplifications intended to mean from the University of Munich (1912). He came to the the same, but considered "better" because they were more United States and was associated with Cornell University concise. They are Class I, benign; Class II, atypical be-College of Medicine from 1914 until his death in 1962. nign; Class III, suspicious; Class IV, probably malignant; Initially, Papanicolaou studied cells exfoliated from the and Class V, malignant. vaginal epithelium of guinea pigs. He explored cytologic
The first-generation Papanicolaou trainees had fairly changes in the vaginal fluid of rodents and then applied uniform ideas, but as more cytologists and pathologists the techniques to the human female to study the sex (and in the early days gynecologists who learned to intercycle and reproductive function. Having established a pret Pap smears and often established and ran the diagnossatisfactory technique for examination of vaginal smears, tic laboratories) enbraced the technique, the method of Papanicolaou began to apply this to diagnose uterine reporting varied. Some pathologists [3] developed and cancer between 1923 and 1928 and first presented his advocated terminology using diagnostic terms, such as findings in 1928 at the Third Race Betterment Confermild, moderate, and severe dysplasia, carcinoma in situ ence. About the same time there was a well-illustrated (CIS), and invasive carcinoma. Others [4] proposed and publication with similar findings by Babes . Papanicoadopted the term "cervical intraepithelial neoplasia" laou, however, was fortunate enough to work closely with (CIN), the categories of which (CIN 1, 2, 3) corresponded clinicians Herbert Traut and Andrew Marchetti and to to mild, moderate, and severe dysplasia/CIS, respectively. have the support and encouragement of the Dean of the As long as a clinician stayed in one place and was associ-Cornell Medical College, Joseph C. Hinsey, in his work ated with one group of pathologists, there was no maduring the 1930s, a period when other pathologists were jor problem. paying more attention to examination of cells in various THE BETHESDA REPORTING SYSTEM fluids. Such support and encouragement were most important in the development and use of the Pap smear.
With variation in terminology among different groups Papanicolaou first reported vaginal smear findings in an and with the mobility of medical people, problems develobstetrics/gynecology journal in 1941, and subsequently, oped and a committee was formed. The Bethesda System a comprehensive monograph was published [2]. Close for Reporting Cervical/Vaginal Cytologic Diagnoses was cooperation between anatomist (later pathologist) and clideveloped at a National Cancer Institute (NCI)-sponsored nician was the basis for the success of the Pap smear as workshop in December 1988, to provide uniform diagnostic terminology that would facilitate communication be-a diagnostic tool. Consideration of findings in the vaginal