THE BETHESDA

SYSTEM 2001
ANATOMY/HISTOLOGY
 CRITERIA

 Age to initiate screening: Optimum age

unknown; within 3 years of onset of sexual
activity or age 21;Three years after the onset of
sexual activity; no later than age 21

 Frequency: annually in conventional smears and

every 2 yrs in LBP;after age 30, women w/ 3
normal consecutive smears may be screened
every 2-3 yrs
 Health Maintenance, Inc.
 The PIONEER & FIRST in Prepaid Healthcare
 Gynecologic Cytology Report
 (The Bethesda System - 2001)
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 Name : ROSALIE GUELAS Age: 37 Date: December 28, 2007
 LMP / Clinical Data:12/22/07 [ ] Menopause
 Requesting Physician: Dr. B. Javier Contract No.: 192883-CP HMI – 08- 01
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 Specimen adequacy: [X] Satisfactory [ ] Unsatisfactory but evaluated. Reason: ____________________________
 [ ] Unsatisfactory for evaluation. Reason: ___________________________________________
 Microorganism seen: [ ] Trichomonas vaginalis
 [ ] Fungal organism consistent with Candida spp.
 [ ] Shift in flora suggestive of bacterial vaginosis
 [ ] Cellular changes consistent with Herpes Simplex Virus
 [ ] Others
 Inflammation: [x] mild [ ] moderate [ ] severe [ ] suggest follow-up smear after treatment
 Descriptive Interpretation/Diagnoses:
 [X] Negative for Intraepithelial Lesion or Malignancy.
 [X] Reactive cellular changes attributed to: [X] inflammation [ ] atrophy [ ] radiation [ ] IUD
 [ ] Atypical squamous cells: [ ] of undetermined significance, probably reactive. Suggest follow-up smear.
 [ ] cannot exclude HSIL. Please correlate clinically and suggest follow-up smear and/or biopsy
 [ ] Low-grade Squamous Intraepithelial Lesion (LSIL): [ ] with HPV changes [ ] mild dysplasia
 [ ] High-grade Squamous Intraepithelial Lesion (HSIL): [ ] moderate dysplasia [ ] severe dysplasia
 [ ] with features suspicious for invasion [ ] correlate clinically and suggest tissue biopsy
 [ ] Squamous Cell Carcinoma. Suggest tissue biopsy for definitive histologic diagnosis.
 [ ] Glandular cells present: [ ] Atypical [ ] Adenocarcinoma
 [ ] correlate clinically and suggest fractional curettage
 [ ] endometrial cells present in menopausal woman
 Comments and recommendation: ___________________________________________________________


 RAUL C. GONZALES, MD, DPSP

 Pathologist

 SPECIMEN TYPE

 Conventional (Pap smear)

 Liquid-based
 Other
SPECIMEN ADEQUACY
 Satisfactory for evaluation but
limited by…

eliminated
 SPECIMEN ADEQUACY

 Satisfactory for evaluation

 Unsatisfactory for evaluation
 SPECIMEN ADEQUACY
 Satisfactory for evaluation
presence or absence of
endocervical/transformation zone
component and any other quality
indicators
 SPECIMEN ADEQUACY
 Unsatisfactory for evaluation

 Specimen processed and examined, but

unsatisfactory for evaluation of epithelial cell
abnormality because of (specify reason)
e.g., obscuring blood, inflammation, etc.
 Specimen rejected/not processed (specify
reason) e.g., specimen not labeled,
slide broken, etc.
 SPECIMEN ADEQUACY
Squamous cells:
Conventional smear – estimated
minimum of approx. 8, 000 – 12, 000
well-preserved and well-visualized
squamous epithelial cells

LBP – minimum limit of 5, 000 well-

preserved and well-visualized squamous
epithelial cells
 SPECIMEN ADEQUACY
Squamous cells:
Conventional smear – estimated
minimum of approx. 8, 000 – 12, 000
well-preserved and well-visualized
squamous epithelial cells

LBP – minimum limit of 5, 000 well-

preserved and well-visualized squamous
epithelial cells
 SPECIMEN ADEQUACY
Endocervical / Transformation
zone component:
 At least 10 well-preserved

endocervical or squamous
metaplastic cells
 SPECIMEN ADEQUACY
Obscuring Factors:
Satisfactory:
50 – 75% of cells obscured

Unsatisfactory:
> 75% of cells obscured
SPECIMEN ADEQUACY

Any specimen with

abnormal cells
is by definition satisfactory for
evaluation!
 Specimen Adequacy
 Sample reporting:
Satisfactory for evaluation. No
endocervical / T-zone component is
identified. Approximately 60% of the
cells are partially obscured by thick
areas.
Specimen processed and examined, but
unsatisfactory for evaluation of epithelial
abnormality because of obscuring
inflammation.
 Intermediate Cell Nucleus
 Standard reference or internal
control
 Nuclear area of 35 µm2 or 7 to 8 µm
diameter = rbc
 Chromatin pattern
 Squamous
Epithelial Cell Abnormalities
 Nuclear enlargement
• Reactive
 ½ to 2x

• ASCUS
 2 ½ to 3x

• Dysplastic
 At least 3x
 Squamous
Epithelial Cell Abnormalities
 Dysplastic cell
• “Big and dark” nuclei

 Grade of dysplasia
• Amount of cytoplasm
• N/C ratio

 Nuclear membrane irregularities

 GENERAL CATEGORIZATION
(optional)
 Negative for intraepithelial lesion or
malignancy
 Epithelial cell abnormality: See
Interpretation/Result (specify
squamous or glandular as
appropriate)
 Other: See Interpretation/Result
(e.g. endometrial cells in a woman ≥
40 years of age)
INTERPRETATION / RESULT
NEGATIVE FOR
INTRAEPITHELIAL LESION OR
MALIGNANCY

 Organisms:
- “Infections” to “Organisms”
- Shift in vaginal flora suggestive of
bacterial vaginosis
INTERPRETATION / RESULT
NEGATIVE FOR INTRAEPITHELIAL
LESION OR MALIGNANCY
 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 Herpes
simplex virus
Intermediate cells

Trichomonas
Inflammatory cells

Reactive cellular changes

 Spores

Hyphae