Bethesda 2001

The Bethesda system (TBS) for reporting cervical/vaginal cytological diagnoses was originally developed in 1988 at a National Cancer Institute (NCI) workshop convened to consider the benefits of increased standardization in the diagnostic reports provided by cytology laboratories. It rapidly gained acceptance in laboratory practice in the USA and beyond and three years later the NCI sponsored another workshop to assess the use of TBS in practice and consider areas for improvement. Subsequently an illustrated guide was published.     

Bethesda 2001. Impact on the reporting of gynecologic cytology

OBJECTIVE: To examine the impact of implementing Bethesda 2001 in one laboratory. STUDY DESIGN: A computer search identified all cervicovaginal specimens evaluated between July 2001 and June 2002. Bethesda 2001 was implemented on January 1, 2002. The rates of specimen adequacy and the frequency of each diagnostic category 6 months before and 6 months after the implementation of Bethesda 2001 were compared. RESULTS: A total of 21,332 cervicovaginal specimens were evaluated during the study period. During the first 6 months, 10,695 specimens were examined; 40% were liquid-based preparations. During the next 6 months, 10,367 specimens were examined; 60% were liquid-based preparations. Prior to the implementation of Bethesda 2001, the percentages of each category were as follows: 74.99% within normal limits, 7.10% reactive/reparative cellular changes (R/R), 10.29% atypical squamous cells (ASC), 0.24% atypical glandular cells (AGC), 3.45% low grade squamous intraepithelial lesion (LSIL), 3.44% high grade squamous intraepithelial lesion (HSIL) and 0.73% unsatisfactory. In addition, 19.00% were classified as "satisfactory but limited by" (SBLB). Following the implementation of Bethesda 2001, the percentages of each category were as follows: 80.09% negative for intraepithelial lesion and malignancy including 6.94% with the qualifier R/R, 10.32% ASC, 0.27% AGC, 4.54% LSIL, 3.44% HSIL and 0.81% unsatisfactory. In addition, 17.40% were satisfactory with a quality indicator (SAT with QI). The incidence of reporting benign endometrial cells in patients over age 40 was the same for both periods. There was a significant decrease in the percentage of specimens classified as SAT with QI when compared to that of specimens classified as SBLB. A statistically significant increase in the percentage of specimens was noted in the category LSIL (P < or = .001) and satisfactory (.005) after implementing Bethesda 2001. No significant changes were noted in other categories. CONCLUSION: Our laboratory experienced some changes in the laboratory statistics of reporting gynecologic cytology after the implementation of Bethesda 2001. Continuous monitoring of reporting trends is indicated to clearly understand the impact of Bethesda 2001 on laboratory statistics.     

Thyroid cytopathology: Bethesda and beyond

Thyroid nodules are commonly encountered in clinical practice. Although the overwhelming majority of them turn out to be benign, the small subset of cancerous nodules needs to be accurately identified for optimal and timely surgical management. Fine-needle aspiration has proven to be the most valuable diagnostic modality for pre-operative distinction of benign from malignant nodules. The recently introduced and much anticipated Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has standardized our diagnostic approach to reporting and cytomorphological criteria. TBSRTC has well-defined and rational management algorithms with implicit risk of malignancy in each of the 6 diagnostic categories. Recently published data supports the clinical utility and wide acceptance of TBSRTC by both practicing pathologists and clinicians. The problematic category of 'indeterminate' cytopathologic diagnoses has led to the discovery and development of unique and useful molecular markers, such as BRAF, which have displayed promising potential in recently published studies. As a result of the publication of TBSRTC, in 2009 the American Thyroid Association revised its clinical guidelines for the management of patients with thyroid disease and TBSRTC offers a useful source of information for the pathologist as well.     

Second edition of 'The Bethesda System for reporting cervical cytology' - atlas, website, and Bethesda interobserver reproducibility project

A joint task force of the American Society of Cytopathology (ASC) and the National Cancer Institute (NCI) recently completed a 2-year effort to revise the Bethesda System "blue book" atlas and develop a complementary web-based collection of cervical cytology images. The web-based collection of images is housed on the ASC website, which went live on November 5th, 2003; it can be directly accessed at http://www.cytopathology.org/NIH/.     

Introduction of the Bethesda System to Mainland China with a Web-based tutorial

OBJECTIVE: To validate the use of a Web-based tutorial to introduce the Bethesda System (TBS) to Mainland Chinese laboratories. STUDY DESIGN: Digitized color images of the diagnostic features in 20 Pap smears were displayed on a Web page. Participants were asked to give each smear a diagnosis using the reporting nomenclature employed in their laboratory or one that was familiar to them. This was followed by teaching images of each smear accompanied by text in English and Chinese that highlighted important features for making a diagnosis using TBS. Participants then reviewed the 20 original Pap smears and rendered a diagnosis using TBS. RESULTS: Pathologists and cytotechnologists at 17 laboratories located in 10 cities completed the exercise. The average diagnostic accuracy for the 20 Pap smears before and after the tutorial was 76% and 88%, respectively. CONCLUSION: Web-based tutorials can be used for disseminating cytologic information to widely dispersed laboratories in China and help enhance the practice of cytology, currently an underutilized diagnostic technique. However, such difficulties as lack of Internet connections in the laboratory, outdated computers and a lack of interest in cytology need to be overcome to ensure success.     

Clinical significance of atypical glandular cells by the 2001 Bethesda System in cytohistologic correlation

OBJECTIVE: To evaluate incidence, cytology findings and pathology outcome of atypical glandular cells (AGC) in Pap smears according to the 2001 Bethesda criteria. STUDY DESIGN: From 103,073 consecutive Pap smears, 113 (0.1%) AGC cases were identified. Of these, 91 (80%) had adequate histologic evaluation included in this study. RESULTS: Abnormal histology findings were seen in 38 patients (42%). Final pathology results revealed 14 endometrial adenocarcinomas, 5 endocervical adenocarcinomas, 1 cervical squamous cell carcinoma, 1 endometrial stromal sarcoma, 6 other malignancies, 4 endocervical adenocarcinomas in situ, 4 cases ofendometrial complex byperplasia, 1 case of endocervical glandular dysplasia and 2 cases of cervical intraepithelial neoplasia 3 with glandular involvement. Women with AGC, favor neoplasia, were more likely to have significant pathology than those with AGC, not otherwise specified, 74% vs. 33% (p = 0.002). Some characteristic background cytologic findings were also noticed in most cases of endometrial, fallopian tube and endocervical adenocarcinoma. CONCLUSION: A diagnosis of AGC is more clinically significant by the 2001 Bethesda System, especially the "AGC, favor neoplastic" category. Some background cytologic features are important because they are indicators of malignancy.