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The Bethesda system and evaluation of abnormal pap smears

✍ Scribed by Hoa N. Nguyen; Staffan R.B. Nordqvist

Publisher: John Wiley and Sons
Year: 1999
Tongue: English
Weight: 32 KB
Volume: 16
Category: Article
ISSN: 8756-0437
DOI: 10.1002/(sici)1098-2388(199904/05)16:3<217::aid-ssu4>3.0.co;2-u

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✦ Synopsis

The Bethesda Pap Smear system and its 1991 revisions aim to simplify Papanicolaou (Pap) smear reporting and make it more reproducible. It redefines the Pap smear request as a medical consultation. The pathologist consultant is required not only to provide the smear reading but also its clinical recommendation. The Bethesda system insists on a detailed Pap smear report assessing specimen adequacy and types of epithelial changes. Squamous cell abnormalities are grouped according to their biologic potential. Both cervical intraepithelial neoplasia, grade I (CIN I) (mild dysplasia) and human papillomavirus (HPV) lesions are grouped together as low-grade squamous intraepithelial lesions (LGSIL), while moderate and severe dysplasia (CIN II and III) belong to the high-grade squamous intraepithelial lesion (HGSIL) category. Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGCUS) need further qualification as to whether they favor either a reactive or neoplastic process. Guidelines for management of abnormal Pap smears are discussed in detail.

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