Bethesda 2014

Bethesda 2014 – Reporting

The Bethesda System for reporting cervico-vaginal cytology reports dates back to December 1988.

Following the first introduction of terminology in 1988, revisions have already taken place in 1991, 2001 and recently in 2014.

For the diagnosis to be made according to the Bethesda 2014 System nomenclature, the interpretative cytology report must comply with certain parameters described below.

Specimen Type

• conventional smear (Pap smear)
• liquid-based preparation
• 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
Other: See Interpretation/Result (e.g., endometrial cells in a woman >=45 years of age)
Epithelial Cell Abnormality: See Interpretation/Result (specify ‘squamous’ or ‘glandular’ as appropriate)

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)

Non-Neoplastic Findings (optional to report)
* Non-neoplastic cellular variations
   – Squamous metaplasia
   – Keratotic changes
   – Tubal metaplasia
   – Atrophy
   – Pregnancy-associated changes

* Reactive cellular changes associated with:
   – Inflammation (includes typical repair)
   – Lymphocytic (follicular) cervicitis
   – Radiation
   – Intrauterine contraceptive device (IUD)

* Glandular cells status post hysterectomy

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
* Cellular changes consistent with cytomegalovirus

OTHER
Endometrial cells (in a woman >=45 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)