The 2001 Bethesda System Terminology - American Family Physician

Specimen Adequacy TBS 1991 reported the adequacy of cervical cytology preparations in three categories: “satisfactory,”“unsatisfactory,”and “satisfactory but limited by,” or SBLB. SBLB included factors such as the lack of transformation zone components and the presence of partially obscuring factors (i.e., blood or inflammation). This category was confusing to some clinicians and prompted unnecessary repeat testing. It has been shown that the presence of endocervical cells as a quality indicator of adequate sampling increases the detection of cervical abnormalities; however, other studies have not demonstrated that a lack of transformation zone components in otherwise negative specimens indicates a higher risk of subsequent detection of histologic high-grade squamous intraepithelial lesions (HSIL). Lack of endocervical cells has not been shown to be associated with an excess of disease in longitudinal studies in which histologic disease, T he Bethesda System (TBS) for reporting cervical or vaginal cytologic diagnoses was introduced in 1988 and revised in 1991 to establish uniform terminology and standardize diagnostic reports. In addition, it introduced a standardized approach for reporting if an individual specimen is adequate for evaluation. TBS 2001 was developed through a process that involved committee review of the literature, solicitation of expert opinions, and discussion of the proposed changes on an interactive Web site. [Evidence level C, consensus/expert guidelines] The terminology of TBS 2001, which was adopted in May 2001, includes revisions in statements of adequacy, general categorization, and interpretation and results of epithelial cell abnormalities (Table 1). The AmeriThe 2001 Bethesda System for reporting cervical or vaginal cytologic diagnoses is an incremental change in the uniform terminology introduced in 1988 and revised in 1991. The 2001 Bethesda System includes specific statements about specimen adequacy, general categorization, and interpretation and results. In the adequacy category, “satisfactory” and “unsatisfactory” are retained, but “satisfactory but limited by” is eliminated. The new category of “atypical squamous cells” (ASC) replaces the category of “atypical squamous cells of undetermined significance” (ASCUS) and is divided into qualifiers of (1) ASC of “undetermined significance” (ASC-US) and (2) “cannot exclude high-grade squamous intraepithelial lesion (HSIL),” or (ASC-H). The categories of ASCUS, “favor reactive” and “favor neoplasia” are eliminated. The terminology for low-grade squamous intraepithelial lesions (LSILs) and HSILs remains unchanged. The category of “atypical glandular cells of undetermined significance” (AGUS) is eliminated to avoid confusion with ASCUS and is replaced by the term “atypical glandular cells” (AGC), with attempts to identify whether the origin of the cells is endometrial, endocervical, or unqualified. “Endocervical adenocarcinoma in situ” and “AGC, favor neoplastic” are included as separate AGC categories. The presence of normal or abnormal endometrial cells is to be reported in women who are at least 40 years of age. Educational notes and comments on ancillary testing may be added as appropriate. (Am Fam Physician 2003;68:1992-8. Copyright© 2003 American Academy of Family Physicians) The 2001 Bethesda System Terminology