Cervical cancer screening: A never-ending developing program

Table 1 The Bethesda system

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 conventional smear (Pap smear)

Other: see interpretation/result (e.g., endometrial cells in a woman ≥ 40 yr 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

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 HSV

Other non neoplastic findings (optional to report; list not inclusive):

Reactive cellular changes associated with:

Inflammation (includes typical repair)

Radiation

IUD

Glandular cells status post hysterectomy

Atrophy

Other:

Endometrial cells (in a woman ≥ 40 yr of age): specify if “negative for SIL”

Epithelial cell abnormalities:

Squamous cell:

ASC:

Of undetermined significance (ASC-US)

Cannot exclude H-SIL (ASC-H)

Low-grade SIL (L-SIL) (encompassing: HPV/mild dysplasia/CIN1)

High-grade SIL (H-SIL) (encompassing: moderate and severe dysplasia, CIS/CIN2 and CIN3):

With features suspicious for invasion (if invasion is suspected)

SCC

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

NOS

Other malignant neoplasms (specify)

Ancillary testing: provide a brief description of the test methods and report the result so that it is easily understood by the clinician

Automated review: if case examined by automated device, specify device and result

Educational notes and suggestions (optional): suggestions should be concise and consistent with clinical follow-up guidelines published by professional organizations (references to relevant publications may be included)

Adapted from: International Agency for Research on Cancer (IARC), 2013. AIS: Adenocarcinoma in situ; NOS: Not otherwise specified; SCC: Squamous cell carcinoma; CIN: Cervical intraepithelial neoplasia; CIS: Carcinoma in situ; IUD: Intrauterine contraceptive device; SIL: Squamous intraepithelial lesion; ASC: Atypical squamous cells.