By Robert J. Kurman, Diane Solomon
THE BETHESDA method FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES used to be constructed at a countrywide melanoma Institute backed workshop in December 1988 to supply uniform diagnostic terminology that might facilitate communique among the laboratory and the clinician. The layout of The Bethesda approach file features a descriptive prognosis and an assessment of specimen adequacy. The Bethesda approach we designed to be versatile so that it might probably evolve based on altering wishes in cervical melanoma screening in addition to to advances within the box of cervical pathology. as a consequence, a moment workshop was once held in April 1991 to judge the influence of The Bethesda method in real perform and to amend and alter it the place wanted. one of many significant thoughts of this moment assembly was once that specified standards will be formulated for either the diagnositic phrases and for the descriptors of specimen adequacy. that's the meant objective of this file.
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Extra resources for The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses: Definitions, Criteria, and Explanatory Notes for Terminology and Specimen Adequacy
Acute radiation-induced changes generally disappear several weeks after therapy completion. However, in some patients alterations may persist indefinitely. These chronic changes can include nuclear enlargement, mild hyperchromasia, and persistent polychromatic staining reaction of the cytoplasm. Certain chemotherapeutic agents may produce changes in cervical epithelial cells ~imilar to those seen with acute and chronic radiation effect. The reactive glandular cell clusters occasionally seen in women with IUDs may represent either endometrial or endocervical columnar cells.
FIGURE 29. ASCUS: Atypical squamous cells associated with atrophy. 41 42 The Bethesda System Hyperkeratosis, parakeratosis, and dyskeratosis are descriptors that have been used inconsistently in the past and are not included in TBS terminology. The classification of cellular changes previously termed "dyskeratosis," "hyperkeratosis," and "parakeratosis" depends on the cytoplasmic and nuclear alterations present. Anucleate, but otherwise unremarkable mature polygonal squamous cells, so-called hyperkeratosis, may indicate a benign reactive cellular change.
The term "lesion" rather than "neoplasia" is used to convey the uncertain biologic potential in an individual patient. The spectrum of cytologic abnormalities in this group is subdivided into two categories as opposed to three or four for several reasons: (1) previous studies have reported low inter- and intraobserver reproducibility with conventional three- and four-grade classification systems, (2) in the current management of HSILs in the United States, nuances oflesion grade are not relevant, (3) accumulated data from natural history studies comparing lowand high-grade lesions imply differences between low- and high-grade intraepithelial lesions, although the biologic behavior of an individual abnormality, whether high or low grade, cannot be predicted.
The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses: Definitions, Criteria, and Explanatory Notes for Terminology and Specimen Adequacy by Robert J. Kurman, Diane Solomon