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CYT 2113 Cytology I

Lesson 11
The Bethesda System II

Automated review
If the case is examined by an automated
device, indicate whether the scanning was
successful, the device and the manufacturers

Computer Assisted Interpretation

of Cervical Cytology
The type of instrumentation used should be
provided in the report
Data generated from screening devices that
are not intended for patient care, but may be
used for internal laboratory quality assurance,
should not be included in the report
Whether or not the specimen was successfully
processed by the device, regardless of the
result, should be reported

If the automated screening provides an

interpretation of the specimen that replaces
manual screening/review, then the result and
any adequacy data derived from the computer
assessment should be stated in the report
If there is no manual screening, i.e. automated
primary screening only, then, in general, no
name should appear on the report that can be
misconstrued as a person who examined the

Results generated by the instrument must be

reviewed and verified by a laboratorian with
appropriate training and authorization
A record of who performed this data
verification should be maintained as an
internal laboratory record
If a specimen is manually screened or
reviewed following automated screening, then
the results of both methods must be
compared and any discrepancy reconciled

Ancillary testing
Include the method (name and brief description)
used for reflex human papillomavirus (HPV) test
Results for reflex HPV test can be reported as:
 A result only
 As a result with a recommendation for clinical
 As a result plus the probability of an associated
 As a definitive interpretation that reflects both
the cytomorphology and the HPV status

Negative for intra-epithelial lesion or
When there is no cellular evidence of
neoplasia, state this in the General
Categorization previously mentioned and/or in
the Interpretation/Result section of the
report, indicate whether or not there are
organisms or other nonneoplastic findings

Trichomonas vaginalis
Fungal organisms morphologically consistent
with Candida spp.
Shift in flora suggestive of bacterial vaginosis
Bacterial morphologically consistent with
Actinomyces spp.
Cellular changes consistent with herpes
simplex virus

Individual squamous cells covered by a layer

of bacteria that obscures the cell membrane
(clue cells)

NILM: cellular changes consistent with Herpes

simplex virus. Nuclei showing ground-glass
appearance. Multinucleation and dense
eosinophilic intranuclear inclusions surrounded by a
halo are also seen

Other non-neoplastic findings

Reactive cellular changes associated with:
Inflammation (includes typical repair)
Intrauterine contraceptive device
Glandular cells status post-hysterectomy

NILM: Reactive cellular changes associated with

Cells with enlarged nuclei, abundant vacuolated
polychromatic cytoplasm, mild nuclear
hyperchromasia without coarse chromatin,
prominent nucleoli

NILM: Atrophy
Parabasal cells with occasional pyknotic
degenerated cells. Globular collections of
basophilic amorphous material (blue blobs) present

Endometrial cells after age 40, particlularly
out of phase or after menopause may be
associated with benign endometrium,
humoral alterations and less commonly,
endometrial/uterine abnormalities
Clinical correlation is recommended

Endometrial Cells

Epithelial cell abnormalities

Squamous cell
Atypical squamous cells of undetermined
Atypical squamous cells cannot exclude highgrade squamous intra-epithelial lesion
Low-grade squamous intra-epithelial lesion,
encompasses HPV/mild dysplasia/cervical
intra-epithelia neoplasia (CIN) 1

High-grade squamous intra-epithelia lesion,

encompasses moderate-to-severe dysplasia,
CIN 2, CIN 3/carcinoma in situ
Suspicious for invasive squamous-cell
Squamous-cell carcinoma

Glandular cell
Glandular cells
Endocervical cells
Endometrial cells
Endocervical cells, favour neoplastic
Glandular cells, favour neoplastic

Endocervical adenocarcinoma in situ

Other malignant neoplasms
Includes sarcoma, malignant lymphoma and

Atypical Squamous Cells

Metaplastic cells with enlarged nuclei and
nuclear contour irregularities showing
variation in size, shape and ratio of nuclear
to cytoplasmic area

Epithelial Abnormalities: Squamous

HPV nuclear and cytoplasmic changes (binucleation
and koilocytosis) are consistent with LSIL

HSIL. Severely dysplastic cells on the left

display a high nuclear to cytoplasmic ratio and
irregular nuclear membranes. Moderately
dysplastic cells on the right have similar nuclei
and more cytoplasm.

Isolated abnormal cells with evenly distributed
coarse chromatin, centrally placed enlarged
nuclei, and dense / metaplastic cytoplasm
are consistent with HSIL

Epithelial Abnormalities: Glandular

Atypical endocervical cells

Sheet of cells with enlarged round or oval
nuclei. Cell borders are well-defined. Mitotic
figures are noted.

Other Malignant Neoplasms

Other malignant neoplasms: metastatic gastric

A clean background is a common finding
compatible in metastatic rather than primary
tumours of the cervix

Other malignant neoplasms: sarcoma

Single giant cells with malignant nuclear features is
present in a bloody background.

Educational Notes and Suggestions

Suggestions are optional
Should be carefully crafted, concise and
consistent with published clinical follow-up
Examples where educational notes may be used:
 Negative cytology reports to highlight the
limitations of cervical cytology
 Alerting clinicians to references containing
consensus guidelines published by different
professional organizations

Examples where suggestions may be useful:

 On unsatisfactory specimens: to improve the
quality of a repeat specimen
 To identify patients with cytologic findings that
may require further triage and management
 When morphologic findings are ambigous
 In complex cases, if direct contact with provider is
not feasible, general statements such as suggest
follow-up as clinically indicated or further
patient follow-up procedures are suggested as
clinically indicated can be used