Bethesda 2001 Reporting System

(Implemented at FAHC January 1, 2002)

SPECIMEN ADEQUACY:

SATISFACTORY FOR EVALUATION

Evaluation of transformation zone component

Satisfactory for evaluation, transformation zone component present
Satisfactory for evaluation, transformation zone component absent
Satisfactory for evaluation, assessment of transformation zone not applicable (e.g. atrophy, vaginal sample, hysterectomy)

Possible Quality Indicators

lack of pertinent clinical information (e.g. LMP not provided)
scant squamous epithelial component
scant squamous epithelial component secondary to excessive blood
scant squamous epithelial component secondary to excessive inflammation
scant squamous epithelial component secondary to excessive mucus
air drying/cellular degeneration
obscuring blood*
obscuring inflammation*
obscuring lubricant contamination*
thick areas in the slide preparation*
cellular degeneration*
(*obscuring factors preclude the interpretation of 50-75% of the epithelial cells)

UNSATISFACTORY FOR EVALUATION

Possible Quality Indicators

acellular sample submitted
insufficient numbers of squamous epithelial cells (less than 10% of expected cellularity)
insufficient numbers of squamous epithelial cells (less than 10% of expected cellularity), sample preparation compromised by excessive blood
insufficient numbers of squamous epithelial cells (less than 10% of expected cellularity), sample preparation compromised by excessive inflammation
insufficient numbers of squamous epithelial cells (less than 10% of expected cellularity), sample preparation compromised by excessive mucus
obscuring blood, which precludes interpretation of 75% or more of the epithelial cells
obscuring inflammation, which precludes interpretation of 75% or more of the epithelial cells
excessive thick areas in the slide preparation, which precludes interpretation of 75% or more of the epithelial cells
obscuring lubricant contamination, which precludes interpretation of 75% or more of the epithelial cells
air drying artifact, which precludes interpretation of 75% or more of the epithelial cells.

GENERAL CATEGORIZATION:

Unsatisfactory for Evaluation

Specimen rejected/not processed, see comment
Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality.

Negative for Intraepithelial Lesion or Malignancy
Other: See Interpretation:
Epithelial Cell Abnormality
Malignant Neoplasm

DESCRIPTIVE DIAGNOSIS / INTERPRETATION:

NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY

(Organisms)

Trichomonas vaginalis present
Fungal organisms present morphologically consistent with Candida species
Shift in flora present suggestive of bacterial vaginosis
Bacteria present morphologically consistent with Actinomyces species
Cellular changes consistent with Herpes simplex virus present

(Reactive Cellular Changes)

Reactive cellular changes associated with inflammation present (includes typical repair)
Reactive cellular changes associated with radiation present
Reactive cellular changes associated with an Intrauterine Contraceptive Device (IUD) present
Glandular cells present status post hysterectomy

OTHER, See Interpretation:

Endometrial cells present in a woman equal to or greater than age 40
Negative for Intraepithelial Lesion or Malignancy

EPITHELIAL CELL ABNORMALITY

Squamous Cell Abnormality - Atypical squamous cells - undetermined significance
Squamous Cell Abnormality - Atypical squamous cells - cannot exclude HSIL
Squamous Cell Abnormality - Low grade squamous intraepithelial lesion (LSIL)
Squamous Cell Abnormality - Low grade squamous intraepithelial lesion cannot exclude HSIL
Squamous Cell Abnormality - High grade squamous intraepithelial lesion (HSIL)
Squamous Cell Abnormality - High grade squamous intraepithelial lesion (HSIL), with features suspicious for invasion
Glandular Cell Abnormality - Atypical endocervical cells, see comment
Glandular Cell Abnormality - Atypical endometrial cells, see comment
Glandular Cell Abnormality - Atypical glandular cells, see comment
Glandular Cell Abnormality - Atypical endocervical cells, favor neoplastic process
Glandular Cell Abnormality - Atypical glandular cells, favor neoplastic process
Glandular Cell Abnormality - Endocervical adenocarcinoma-in-situ (AIS)

MALIGNANT NEOPLASMS:

Squamous Cell Carcinoma
Adenocarcinoma
Endocervical
Endometrial
Extrauterine
Not otherwise specified (NOS)
Other malignant neoplasms

RECOMMENDATIONS/EDUCATIONAL NOTES:

The following recommendation is used for all cases reported as ASC-US, and above.

FAHC recommends following the "2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities" (JAMA,2002;287:2120-9). Management algorithms have been distributed by FAHC and are available online at http://www.asccp.org/consensus.shtml

The following recommendation is placed on reports for women > 40 with endometrial cells.

Benign appearing endometrial cells on Pap tests are usually a normal finding in women with regular menstrual cycles, especially if the Pap was collected during the first half of the menstrual cycle. There is data showing that endometrial cells on Pap tests may be associated with endometrial/uterine abnormalities in post menopausal women or in premenopausal women with abnormal bleeding. There is limited data on the significance of benign endometrial cells in post menopausal women on HRT. Clinical correlation is recommended.

Note: The Pap test is not an accurate test for the screening of endometrial lesions and should not be used as a follow up in patients with clinical suspicion of endometrial pathology.

Other recommendations used, as appropriate:

Recommend clinical correlation and further evaluation, as clinically indicated.

Recommend repeat Pap test following clearing of infection/ inflammation, as clinically indicated.

A satisfactory interpretation can not be made due to atrophic changes. Recommend a limited 2 week course of intravaginal estrogen cream (2 grams) for 3 nights each week, with a repeat Pap test 3 to 7 days after conclusion of estrogen therapy.

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