The Pap test and Bethesda 2014.

The history of “The Bethesda System” (TBS) for reporting cervical cytology goes back almost 3 decades. This terminology and the process that created it have had a profound impact on the practice of cervical cytology for laboratorians and clinicians alike. The Bethesda conferences and their ensuing output have also set the stage for standardization of terminology across multiple organs systems, including both cytology and histology; have initiated significant research in the biology and cost-effective management for human papillomavirus (HPV)associated anogenital lesions; and, finally, have fostered worldwide unification of clinical management for these lesions. One snowy weekend in December 1988, a small group of individuals with expertise in cytopathology, histopathology, and patient management met at the National Institutes of Health in Bethesda, Maryland. This meeting, which became the first Bethesda workshop, was chaired by Robert Kurman and focused on addressing the issues related to the wide variability in reporting results of cervical cytology when cytologists used either the numeric “Pap Class” system or the “dysplasia” terminology. The objective was to establish terminology that would provide clear-cut thresholds for management and decrease interobserver variability. During the 2 days of that historic workshop, 3 fundamental principles emerged that have guided TBS to this day: