By Robert J. Kurman, Diane Solomon
THE BETHESDA process FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES was once constructed at a countrywide melanoma Institute backed workshop in December 1988 to supply uniform diagnostic terminology that will facilitate conversation among the laboratory and the clinician. The layout of The Bethesda procedure file features a descriptive prognosis and an review of specimen adequacy. The Bethesda method we designed to be versatile so that it could actually evolve based on altering wishes in cervical melanoma screening in addition to to advances within the box of cervical pathology. to that end, a moment workshop used to be held in April 1991 to guage the influence of The Bethesda procedure in genuine perform and to amend and adjust it the place wanted. one of many significant innovations of this moment assembly used to be that specific standards may be formulated for either the diagnositic phrases and for the descriptors of specimen adequacy. that's the meant goal of this document.
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Additional resources for The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses: Definitions, Criteria, and Explanatory Notes for Terminology and Specimen Adequacy
Example text
Therefore, the presence of such morphologic changes does not add substantively to the diagnosis and does not need to be appended to the diagnosis of SIL. Half to nearly three quarters of invasive cervical cancers contain certain HPV types; these viruses have been referred to as "high-risk" HPVs. High-risk HPVs are associated with both low- and high-grade SIL, but are observed with significantly greater frequency in the high-grade group. Individual cellular features within the morphologic continuum cannot be correlated consistently with HPV DNA types.
The differential diagnosis is between a benign change in reaction to a stimulus versus a LSIL. ' FIGURE 22. ASCUS: Atypical squamous celis, possibly LSIL. FIGURE 23. ASCUS: Atypical squamous celis, possibly LSIL. 35 36 The Bethesda System Changes diagnostic of HPV cytopathic effects-well-defmed, optically clear, perinuclear cavity associated with a peripheral rim of thickened cytoplasm as well as nuclear alterations-are classified as LSIL. Cells with some but not all of these features, which are suggestive of HPV cytopathic effects, are included in the ASCUS category (see Figs.
HSIL should be evaluated by colposcopy and directed biopsy. Management should focus on preventing invasive carcinoma by the most conservative means possible. Mounting evidence over the past 10 years indicates that HPV is a critical factor in the pathogenesis of cervical squamous cell carcinoma. In addition, HPV DNA can be detected by molecular techniques in the vast majority of SILs regardless of the presence of cellular changes of HPVrelated cytopathic effect. Therefore, the presence of such morphologic changes does not add substantively to the diagnosis and does not need to be appended to the diagnosis of SIL.