Cervical / Vaginal Specimens

The National Cancer Institute has published the third edition of “The Bethesda System for Reporting Cervical Cytology,” which refines the reporting system developed in the 2014 Bethesda System Update. The 2014 Bethesda System has been expanded and revised to take into account the advances and experiences in the past decade, while clarifying various technologies and morphologic questions. LabCorp believes that the Bethesda System promotes consistent communication and clarity in reporting cervical cytopathology results. The terminology is detailed below.

The 2014 Bethesda System for Reporting Cervical / Vaginal Cytology

Specimen Type

• Indicate conventional smear (Pap smear) vs. liquid-based preparation vs. other

Specimen Adequacy

• Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and any other quality indicators, e.g., partially obscuring blood, inflammation, etc.)
• Unsatisfactory for evaluation ... (specify reason)
  • Specimen rejected/not processed (specify reason)
  • Specimen processed and examined but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)

General Categorization (Optional)

• Negative for intraepithelial lesion or malignancy
• Other: See Interpretation/Result (e.g., endometrial cells in a woman ≥45 years of age)
• Epithelial cell abnormality: See Interpretation/Result (specify “squamous” or “glandular” as appropriate)

Interpretation/Result

• Negative for intraepithelial lesion or malignancy (When there is no cellular evidence of neoplasia, state this in the General Categorization above and/or in the Interpretation/Result section of the report, whether or not there are organisms or other non- neoplastic findings)

Non-neoplastic Findings (optional to report; list not inclusive)

• Non-neoplastic cellular variations
  • Squamous metaplasia
  • Keratotic changes
  • Tubal metaplasia
  • Atrophy
  • Pregnancy-associated changes
• Reactive cellular changes associated with:
  • Inflammation (includes typical repair)
  • Lymphocytic (follicular) cervicitis
  • Radiation
  • Intrauterine contraceptive device (IUD)
• Glandular cells status post hysterectomy

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 (HSV)
• Cellular changes consistent with cytomegalovirus

Other

• Endometrial cells (in a woman ≥45 years of age)  (Specify if “negative for squamous intraepithelial lesion”)

Epithelial Cell Abnormalities

Squamous Cell

• Atypical squamous cells
  • of undetermined significance (ASC-US)
  • cannot exclude HSIL (ASC-H)
• Low-grade squamous intraepithelial lesion (LSIL) (encompassing: HPV/mild dysplasia/CIN 1)
• High-grade squamous intraepithelial lesion (HSIL) (encompassing: moderate and severe dysplasia, CIS; CIN 2 and CIN 3)
  • with features suspicious for invasion (if invasion is suspected)
• Squamous cell carcinoma

Glandular Cell

• Atypical
  • endocervical cells (NOS or specify in comments)
  • endometrial cells (NOS or specify in comments)
  • glandular cells (NOS or specify in comments)
• Atypical
  • endocervical cells, favor neoplastic
  • glandular cells, favor neoplastic
• Endocervical adenocarcinoma in situ
• Adenocarcinoma
  • endocervical
  • endometrial
  • extrauterine
  • not otherwise specified (NOS)

Other Malignant Neoplasms (specify)

Adjunctive Testing

• Provide a brief description of the test methods and report the result so that it is easily understood by the clinician.

Computer-assisted Interpretation of Cervical Cytology

• If case is examined by automated device, specify device and result.

Educational Notes and Comments (Optional)

• Suggestions should be concise and consistent with clinical follow- up guidelines published by professional organizations (references to relevant publications may be included).

Reference

1. Nayar, Ritu and Wilbur, David C, eds. The Bethesda System for Reporting Cervical Cytology. Definitions, Criteria and Explanatory Notes. Third Edition. Springer International Publishing Switzerland; 2015.