SPECIMEN TYPE:SPECIMEN TYPE: Indicate conventional smear (Pap smear) vs. liquid based vs. Indicate conventional smear (Pap smear) vs. liquid based vs.

otherother

SPECIMEN ADEQUACYSPECIMEN ADEQUACY Satisfactory for evaluation (Satisfactory for evaluation (describe presence or absence of describe presence or absence of

endocervical/transformation zone component and any other endocervical/transformation zone component and any other quality indicators, e.g., partially obscuring blood, inflammation, quality indicators, e.g., partially obscuring blood, inflammation, etc.etc.) )

Unsatisfactory for evaluation ... (Unsatisfactory for evaluation ... (specify reasonspecify reason) ) • Specimen rejected/not processed (Specimen rejected/not processed (specify reasonspecify reason) ) • Specimen processed and examined, but unsatisfactory for evaluation Specimen processed and examined, but unsatisfactory for evaluation

of epithelial abnormality because of (of epithelial abnormality because of (specify reasonspecify reason))

GENERAL CATEGORIZATIONGENERAL CATEGORIZATION ( (optionaloptional) ) Negative for Intraepithelial Lesion or Malignancy Negative for Intraepithelial Lesion or Malignancy Epithelial Cell Abnormality: See Interpretation/Result (Epithelial Cell Abnormality: See Interpretation/Result (specify specify

‘squamous’ or ‘glandular’ as appropriate‘squamous’ or ‘glandular’ as appropriate) ) Other: See Interpretation/Result (Other: See Interpretation/Result (e.g. endometrial cells in a e.g. endometrial cells in a

woman woman ³³ 40 years of age 40 years of age) )

AUTOMATED REVIEWAUTOMATED REVIEW If case examined by automated device, specify device and result.If case examined by automated device, specify device and result.

ANCILLARY TESTINGANCILLARY TESTING Provide a brief description of the test methods and report the Provide a brief description of the test methods and report the

result so that it is easily understood by the clinician.result so that it is easily understood by the clinician.

INTERPRETATION/RESULTINTERPRETATION/RESULT NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCYNEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY

• ORGANISMS: ORGANISMS: Trichomonas vaginalisTrichomonas vaginalis Fungal organisms morphologically consistent with Fungal organisms morphologically consistent with CandidaCandida spp spp Shift in flora suggestive of bacterial vaginosis Shift in flora suggestive of bacterial vaginosis Bacteria morphologically consistent with Bacteria morphologically consistent with ActinomycesActinomyces spp. spp. Cellular changes consistent with Herpes simplex virus Cellular changes consistent with Herpes simplex virus

• OTHER NON NEOPLASTIC FINDINGS (OTHER NON NEOPLASTIC FINDINGS (Optional to report; list not Optional to report; list not inclusiveinclusive): ):

Reactive cellular changes associated with Reactive cellular changes associated with • inflammation (includes typical repair) inflammation (includes typical repair) • radiation radiation • intrauterine contraceptive device (IUD) intrauterine contraceptive device (IUD)

Glandular cells status post hysterectomy Glandular cells status post hysterectomy Atrophy Atrophy

OTHEROTHER Endometrial cells (Endometrial cells (in a woman in a woman ³³ 40 years of age 40 years of age) )

EPITHELIAL CELL ABNORMALITIESEPITHELIAL CELL ABNORMALITIES SQUAMOUS CELL SQUAMOUS CELL

Atypical squamous cells Atypical squamous cells • of undetermined significance (ASC-US) of undetermined significance (ASC-US) • cannot exclude HSIL (ASC-H) cannot exclude HSIL (ASC-H)

Low grade squamous intraepithelial lesion (LSIL)Low grade squamous intraepithelial lesion (LSIL)          encompassing: HPV/mild dysplasia/CIN 1           encompassing: HPV/mild dysplasia/CIN 1

High grade squamous intraepithelial lesion (HSIL)High grade squamous intraepithelial lesion (HSIL)          encompassing: moderate and severe dysplasia, CIS/CIN 2 and CIN 3           encompassing: moderate and severe dysplasia, CIS/CIN 2 and CIN 3

• with features suspicious for invasion (with features suspicious for invasion (if invasion is suspectedif invasion is suspected) ) Squamous cell carcinoma Squamous cell carcinoma

GLANDULAR CELL GLANDULAR CELL Atypical Atypical

• endocervical cells (NOS endocervical cells (NOS or specify in commentsor specify in comments) ) • endometrial cells (NOS endometrial cells (NOS or specify in commentsor specify in comments) ) • glandular cells (NOS glandular cells (NOS or specify in commentsor specify in comments) )

Atypical Atypical • endocervical cells, favor neoplastic endocervical cells, favor neoplastic • glandular cells, favor neoplastic glandular cells, favor neoplastic

Endocervical adenocarcinoma in situ Endocervical adenocarcinoma in situ Adenocarcinoma Adenocarcinoma

• endocervical endocervical • endometrial endometrial • extrauterine extrauterine • not otherwise specified (NOS) not otherwise specified (NOS)

OTHER MALIGNANT NEOPLASMS:OTHER MALIGNANT NEOPLASMS: ( (specifyspecify) ) EDUCATIONAL NOTES AND SUGGESTIONSEDUCATIONAL NOTES AND SUGGESTIONS ( (optionaloptional) )

Specimen AdequacySpecimen Adequacy 1991 Bethesda System: Adequacy of the Specimen1991 Bethesda System: Adequacy of the Specimen

• Satisfactory for evaluationSatisfactory for evaluation• Satisfactory for evaluation but limited by…Satisfactory for evaluation but limited by…• Unsatisfactory for evaluationUnsatisfactory for evaluation

The unsatisfactory category should be maintained because it emphasizes The unsatisfactory category should be maintained because it emphasizes specimen unreliability for evaluation of epithelial lesions.specimen unreliability for evaluation of epithelial lesions.

Unsatisfactory Specimen ReportingUnsatisfactory Specimen Reporting

The “Unsatisfactory” category currently includes both specimens that are The “Unsatisfactory” category currently includes both specimens that are rejected and specimens that are fully evaluated.rejected and specimens that are fully evaluated.

Recommendation:Recommendation: Suggested wording to clarify reports follows:Suggested wording to clarify reports follows: Rejected Pap:Rejected Pap:

• Specimen rejected (not processed) because ____(specimen not labeled, Specimen rejected (not processed) because ____(specimen not labeled, slide broken, etc.)slide broken, etc.)

Fully evaluated unsatisfactory Pap :Fully evaluated unsatisfactory Pap :• Specimen processed and examined, but unsatisfactory for evaluation Specimen processed and examined, but unsatisfactory for evaluation

of epithelial abnormality because of ____(obscuring blood, etc.)of epithelial abnormality because of ____(obscuring blood, etc.)• Additional comments/recommendations, as appropriateAdditional comments/recommendations, as appropriate

Conventional Smear Squamous CellularityConventional Smear Squamous Cellularity““Well-preserved and well-visualized squamous epithelial cells Well-preserved and well-visualized squamous epithelial cells

should cover more than 10% of the slide surface.”should cover more than 10% of the slide surface.”

Recommendation: Recommendation: Change the criterion to “An adequate conventional Change the criterion to “An adequate conventional

specimen has an estimated minimum of approximately specimen has an estimated minimum of approximately 8,000-12,000 well-preserved and well-visualized squamous 8,000-12,000 well-preserved and well-visualized squamous epithelial cells.” epithelial cells.”

Note: THIS MINIMUM CELL RANGE SHOULD BE ESTIMATED, Note: THIS MINIMUM CELL RANGE SHOULD BE ESTIMATED, AND LABORATORIES SHOULD NOT COUNT INDIVIDUAL AND LABORATORIES SHOULD NOT COUNT INDIVIDUAL CELLS IN CONVENTIONAL SMEARS.CELLS IN CONVENTIONAL SMEARS.

Provide “reference images” of known cellularity.Provide “reference images” of known cellularity.

Endocervical/Transformation zone componentEndocervical/Transformation zone component““at a minimum, of two clusters of well-preserved endocervical glandular at a minimum, of two clusters of well-preserved endocervical glandular and/or squamous metaplastic cells, with each cluster composed of at least and/or squamous metaplastic cells, with each cluster composed of at least five cells.” five cells.”

Recommendation:Recommendation:• At least 10 well-preserved endocervical or squamous metaplastic cells should be At least 10 well-preserved endocervical or squamous metaplastic cells should be

observed to report that a transformation zone component is present.observed to report that a transformation zone component is present.• The presence or absence of a transformation zone component should be The presence or absence of a transformation zone component should be

reported in the specimen adequacy section, but absence does not mean a reported in the specimen adequacy section, but absence does not mean a patient requires early repeat.patient requires early repeat.

• Parabasal type cells should not be used as an indication of transformation zone Parabasal type cells should not be used as an indication of transformation zone sampling.sampling.

Obscuring factorsObscuring factors• Current Bethesda criteria are 50-75% of cells obscured for SBLB specimens, and Current Bethesda criteria are 50-75% of cells obscured for SBLB specimens, and

>75% of cells obscured for unsatisfactory specimens>75% of cells obscured for unsatisfactory specimens

Recommendations: Recommendations: • No change in criteria is proposed. Specimens with >75% of cells obscured should No change in criteria is proposed. Specimens with >75% of cells obscured should

be termed unsatisfactory (assuming no abnormal cells are present). When 50-be termed unsatisfactory (assuming no abnormal cells are present). When 50-75% of cells are obscured, a statement describing the specimen as partially 75% of cells are obscured, a statement describing the specimen as partially obscured should follow the satisfactory term. obscured should follow the satisfactory term.

Recommendations and Recommendations and Educational NotesEducational Notes

The Cytology Report is a Medical ConsultationThe Cytology Report is a Medical Consultation

1.1. The cytopathologist has ultimate responsibility for the The cytopathologist has ultimate responsibility for the evaluation and report.evaluation and report.

2.2. The referring physician has an obligation to include all The referring physician has an obligation to include all pertinent clinical information in the request for cytopathologic pertinent clinical information in the request for cytopathologic evaluation so that the cytopathologist can consult effectively.evaluation so that the cytopathologist can consult effectively.

3.3. The cytopathologist should determine whether the The cytopathologist should determine whether the specimen is adequate for evaluation. If it is unsatisfactory or specimen is adequate for evaluation. If it is unsatisfactory or less than optimal, this should be noted on the reportless than optimal, this should be noted on the report

4.4. The report should include a recommendation for further The report should include a recommendation for further patient evaluation when appropriate.patient evaluation when appropriate.

one of the areas examined by a 2001Bethesda System Working one of the areas examined by a 2001Bethesda System Working Committee has been the potential use of recommendations and Committee has been the potential use of recommendations and educational notes, including disclaimer-like notes in the educational notes, including disclaimer-like notes in the cervicovaginal cytology report.cervicovaginal cytology report.

Recommendation:Recommendation:The use of recommendations is therefore considered The use of recommendations is therefore considered appropriate under the following circumstances:appropriate under the following circumstances:

1.1. When further procedures would be helpful to When further procedures would be helpful to clarify ambiguous morphologic findings.clarify ambiguous morphologic findings.2.2. To improve the quality of a repeat specimen To improve the quality of a repeat specimen following one of limited adequacy.following one of limited adequacy.3.3. To identify patients with certain interpretations that To identify patients with certain interpretations that require further triage and potential subsequent require further triage and potential subsequent management.management.

Additional Uses of Educational NotesAdditional Uses of Educational NotesRecommendations:Recommendations:

Educational notes are optional. If used, they should Educational notes are optional. If used, they should be carefully worded, concise, clear and evidence-based.be carefully worded, concise, clear and evidence-based.

Examples of interpretive results with notes and Examples of interpretive results with notes and recommendations:recommendations:

InterpretationInterpretation:: Atypical Glandular Cells Atypical Glandular Cells RecommendationRecommendation: As a significant percentage of patients : As a significant percentage of patients

with this interpretation have underlying high-grade with this interpretation have underlying high-grade squamous or glandular intraepithelial abnormalities, further squamous or glandular intraepithelial abnormalities, further diagnostic patient follow-up procedures are suggested as diagnostic patient follow-up procedures are suggested as clinically indicated.clinically indicated.

----------------------------------------------------

InterpretationInterpretation: Unsatisfactory due to lack of cellular : Unsatisfactory due to lack of cellular material and air-drying artifact (in a post-menopausal material and air-drying artifact (in a post-menopausal woman).woman).

Recommendation:Recommendation: A short course of estrogen cream is A short course of estrogen cream is suggested before obtaining a repeat specimen in order to suggested before obtaining a repeat specimen in order to induce maturation of the squamous epithelium.induce maturation of the squamous epithelium.

Ancillary Testing Ancillary Testing RecommendationsRecommendations

1991 Bethesda Terminology1991 Bethesda TerminologyNone reported for Ancillary TestingNone reported for Ancillary Testing

Recommendation:Recommendation:• For all laboratory based ancillary tests, a brief description of For all laboratory based ancillary tests, a brief description of

the methods should be provided, and the results should be the methods should be provided, and the results should be reported in a manner conducive to clinician understanding. reported in a manner conducive to clinician understanding.

• For HPV testing, the results should be reported as positive or For HPV testing, the results should be reported as positive or negative for HPV DNA of a certain type or class and the negative for HPV DNA of a certain type or class and the laboratory method should be indicated. laboratory method should be indicated.

• HPV testing has been shown to lack utility for triage of women HPV testing has been shown to lack utility for triage of women who have LSIL or HSIL diagnoses. who have LSIL or HSIL diagnoses.

• Thus, given the current data, clinical recommendations Thus, given the current data, clinical recommendations associated with HPV testing should be limited to women who associated with HPV testing should be limited to women who have an ASCUS diagnosis. have an ASCUS diagnosis.

Benign Cellular Changes: Benign Cellular Changes: Recommendations after the Recommendations after the

Bethesda ConferenceBethesda ConferenceBenign Cellular Changes and InfectionsBenign Cellular Changes and InfectionsGENERAL CATEGORIZATION GENERAL CATEGORIZATION

What terminology should be used for negative What terminology should be used for negative and reactive specimens in the General and reactive specimens in the General Categorization?Categorization?

""Negative for intraepithelial lesion or Negative for intraepithelial lesion or

malignancymalignancy" is preferred in the report so that " is preferred in the report so that organisms and other benign cellular changes may be organisms and other benign cellular changes may be included under this general category.included under this general category.

RECOMMENDATION AFTER THE BETHESDA CONFERENCERECOMMENDATION AFTER THE BETHESDA CONFERENCE

GENERAL CATEGORIZATION (Optional)GENERAL CATEGORIZATION (Optional)• Negative for intraepithelial lesion or malignancy (includes Negative for intraepithelial lesion or malignancy (includes

organisms and reactive cellular changes)organisms and reactive cellular changes)• Epithelial cell abnormality: (Specify squamous or glandular as Epithelial cell abnormality: (Specify squamous or glandular as

appropriate) (See interpretation/diagnosis) appropriate) (See interpretation/diagnosis) • Other: (See interpretation/diagnosis) (includes conditions that Other: (See interpretation/diagnosis) (includes conditions that

do not fit under the first two categories such as exfoliated do not fit under the first two categories such as exfoliated endometrial cells in a woman over 40 years of age and non-endometrial cells in a woman over 40 years of age and non-epithelial malignancies)epithelial malignancies)

For Interpretations/Diagnoses include in Bethesda 2001 For Interpretations/Diagnoses include in Bethesda 2001 the following:the following:• Reactive cellular changes associated with:Reactive cellular changes associated with:

Inflammation (includes typical repair)Inflammation (includes typical repair) RadiationRadiation Intrauterine contraceptive device (IUD)Intrauterine contraceptive device (IUD)

• Other FindingsOther Findings

Where should infections be listed within the terminology and in the Where should infections be listed within the terminology and in the report?report?

RECOMMENDATION :RECOMMENDATION : The consensus of opinion at the conference was to change the The consensus of opinion at the conference was to change the

"infections" category to "organisms"."infections" category to "organisms". Modification of the infection listModification of the infection list

RECOMMENDATION :RECOMMENDATION :• OrganismsOrganisms

Trichomonas VaginalisTrichomonas Vaginalis Fungal organisms morphologically consistent with Fungal organisms morphologically consistent with

CandidaCandida spp spp Shift in vaginal flora suggestive of bacterial vaginosisShift in vaginal flora suggestive of bacterial vaginosis Bacteria morphologically consistent with Bacteria morphologically consistent with Actinomyces Actinomyces

sppspp Cellular changes associated with Herpes simplex virusCellular changes associated with Herpes simplex virus OtherOther

Chlamydia should not be listed as an infectious entity in the Bethesda System Chlamydia should not be listed as an infectious entity in the Bethesda System to be diagnosed routinely on Pap smear. (No change)to be diagnosed routinely on Pap smear. (No change)

Change the term "Predominance of coccobacilli consistent with shift in vaginal Change the term "Predominance of coccobacilli consistent with shift in vaginal flora" to "Shift in vaginal flora suggestive of bacterial vaginosis" The flora" to "Shift in vaginal flora suggestive of bacterial vaginosis" The clinician can then use clinical judgment to determine if additional tests or clinician can then use clinical judgment to determine if additional tests or treatment is indicated.treatment is indicated.

Recommendations of the ASCUSRecommendations of the ASCUS

Replace ASCUS with a new category “Atypical Replace ASCUS with a new category “Atypical Squamous Cells (ASC)”Squamous Cells (ASC)”

Eliminate the qualifier, “Favor Reactive” for Eliminate the qualifier, “Favor Reactive” for equivocal cytology. Recommend that equivocal cytology. Recommend that pathologists judiciously downgrade many pathologists judiciously downgrade many cases formerly classified as “ASCUS, Favor cases formerly classified as “ASCUS, Favor Reactive.”Reactive.”

Qualify Atypical Squamous Cells (ASC) as Qualify Atypical Squamous Cells (ASC) as “Undetermined Significance (ASC-US)” or “Undetermined Significance (ASC-US)” or “Cannot Exclude HSIL (ASC-H)”“Cannot Exclude HSIL (ASC-H)”

Atypical Squamous Cells of Undetermined Atypical Squamous Cells of Undetermined Significance (ASC-US)Significance (ASC-US): cytologic changes that are : cytologic changes that are suggestive of a squamous intraepithelial lesion, suggestive of a squamous intraepithelial lesion, but lack criteria for a definitive interpretation. The but lack criteria for a definitive interpretation. The category includes: 1) a minority of cases formally category includes: 1) a minority of cases formally classified as ASCUS, Favor Reactive and 2) most classified as ASCUS, Favor Reactive and 2) most cases formally classified as ASCUS, NOS or cases formally classified as ASCUS, NOS or ASCUS, Favor SIL. ASCUS, Favor SIL.

Atypical Squamous Cells; Cannot Exclude HSIL Atypical Squamous Cells; Cannot Exclude HSIL (ASC-H)(ASC-H): cytologic changes that are suggestive of : cytologic changes that are suggestive of HSIL, but lack criteria for definitive interpretation. HSIL, but lack criteria for definitive interpretation.

ASC reports should not exceed 5% of total ASC reports should not exceed 5% of total specimens with ASC:SIL ratios not higher than 2:1 specimens with ASC:SIL ratios not higher than 2:1 to 3:1 in general screening populations. to 3:1 in general screening populations.

LSIL / HSIL Forum DraftLSIL / HSIL Forum Draft

1991 Bethesda System1991 Bethesda System Squamous Intraepithelial Lesion (SIL)Squamous Intraepithelial Lesion (SIL)

• Low-grade squamous intraepithelial lesion (LSIL)Low-grade squamous intraepithelial lesion (LSIL)• High-grade squamous intraepithelial lesion (HSIL)High-grade squamous intraepithelial lesion (HSIL)

2001 Recommendations2001 RecommendationsTerminology used for squamous intraepithelial lesions. Terminology used for squamous intraepithelial lesions. Recommendation:Recommendation: LSIL and HSIL should continue to be LSIL and HSIL should continue to be

included as two separate categories under Epithelial Cell included as two separate categories under Epithelial Cell Abnormalities - Squamous Cell. Moreover, the dividing line Abnormalities - Squamous Cell. Moreover, the dividing line between LSIL and HSIL should be between CIN 1 (mild between LSIL and HSIL should be between CIN 1 (mild dysplasia) and CIN 2 (moderate dysplasia).dysplasia) and CIN 2 (moderate dysplasia).

Retention of cellular changes associated with HPV cytopathic Retention of cellular changes associated with HPV cytopathic effect (so-called koilocytotic atypia) in the LSIL category. effect (so-called koilocytotic atypia) in the LSIL category.

Recommendation:Recommendation: No modification should be made to TBS in No modification should be made to TBS in this regard and cervical cytology specimens with the cellular this regard and cervical cytology specimens with the cellular features associated with HPV cytopathic effect (e.g., koilocytosis) features associated with HPV cytopathic effect (e.g., koilocytosis) should continue to be included under Epithelial Cell Abnormalities should continue to be included under Epithelial Cell Abnormalities - Squamous Cell – - Squamous Cell – Low-grade squamous intraepithelial lesion Low-grade squamous intraepithelial lesion (LSIL).(LSIL).

Classification of gynecological cytology samples showing HSIL Classification of gynecological cytology samples showing HSIL in which invasion cannot be ruled-out.in which invasion cannot be ruled-out.

Recommendation:Recommendation: Gynecological cytology cases showing Gynecological cytology cases showing diagnostic HSIL in which there is non-diagnostic cytological diagnostic HSIL in which there is non-diagnostic cytological evidence of invasion should be diagnosed as HSILevidence of invasion should be diagnosed as HSIL andand accompanied by the comment “with features suspicious for accompanied by the comment “with features suspicious for invasion”. invasion”.

Proposed 2001 Bethesda SystemProposed 2001 Bethesda System Squamous Intraepithelial Lesion (SIL)Squamous Intraepithelial Lesion (SIL)

• Low-grade squamous intraepithelial lesion (LSIL)Low-grade squamous intraepithelial lesion (LSIL)• High-grade squamous intraepithelial lesion (HSIL)High-grade squamous intraepithelial lesion (HSIL)

Atypical Glandular Cells –Recommendations Atypical Glandular Cells –Recommendations revised post-meetingrevised post-meeting

AIS as a discrete entity; Atypical Glandular Cell QualifiersAIS as a discrete entity; Atypical Glandular Cell Qualifiers

Recommendations: Recommendations: ““Endocervical adenocarcinoma in situEndocervical adenocarcinoma in situ” should be added as a discrete ” should be added as a discrete

interpretation/diagnosis when criteria are adequate for this interpretation. interpretation/diagnosis when criteria are adequate for this interpretation. In cases showing near complete features (criteria) of AIS, an intermediate In cases showing near complete features (criteria) of AIS, an intermediate category of “Atypical endocervical cells, probably AIS” is appropriate category of “Atypical endocervical cells, probably AIS” is appropriate

The category The category “Atypical glandular/endocervical/endometrial cells” “Atypical glandular/endocervical/endometrial cells” should be should be retained, however, retained, however,

The qualifierThe qualifier “of undetermined significance” (AGUS) “of undetermined significance” (AGUS) should be eliminated to should be eliminated to avoid confusion with ASCUS. avoid confusion with ASCUS.

In addition, the qualifier “favor reactive” should be eliminated. The qualifier In addition, the qualifier “favor reactive” should be eliminated. The qualifier “favor neoplastic” should be retained;“favor neoplastic” should be retained;

Categories under the “atypical glandular” heading:Categories under the “atypical glandular” heading:• Atypical Glandular/Endocervical/Endometrial Cells Atypical Glandular/Endocervical/Endometrial Cells

(unqualified)(unqualified)• Atypical Glandular/Endocervical Cells, Favor NeoplasticAtypical Glandular/Endocervical Cells, Favor Neoplastic

specify further in descriptionspecify further in description

The Presence of Benign Glandular Cells in the The Presence of Benign Glandular Cells in the Specimens from Post-Hysterectomy WomenSpecimens from Post-Hysterectomy Women

Data from the literature show that no patient having Data from the literature show that no patient having benign glandular cells in vaginal smears post-benign glandular cells in vaginal smears post-hysterectomy developed recurrent or de novo hysterectomy developed recurrent or de novo neoplastic lesions regardless of the history of neoplastic lesions regardless of the history of prior malignancy. prior malignancy.

Recommendations:Recommendations:• ““Low grade glandular intraepithelial lesion” and/or Low grade glandular intraepithelial lesion” and/or

“endocervical glandular dysplasia” should not be “endocervical glandular dysplasia” should not be utilized. utilized.

• Proposed criteria for AIS and Atypical Glandular Cells Proposed criteria for AIS and Atypical Glandular Cells were presented at the meeting. were presented at the meeting.

Bethesda 2001 Endometrial Forum Bethesda 2001 Endometrial Forum Group Workshop SummaryGroup Workshop Summary

An introductory comment for TBS 2001 was An introductory comment for TBS 2001 was formulated: “Cervical/vaginal cytology is a formulated: “Cervical/vaginal cytology is a screening tool for squamous cell carcinoma and screening tool for squamous cell carcinoma and its precursor lesions. It is an inaccurate test for its precursor lesions. It is an inaccurate test for detection of endometrial lesions and should not detection of endometrial lesions and should not be used to evaluate causes of suspected be used to evaluate causes of suspected endometrial abnormalities.”endometrial abnormalities.”

Recommendation: Recommendation: • Because of the lack of clinical impact and the unreliable Because of the lack of clinical impact and the unreliable

clinical data often supplied with the sample, endometrial clinical data often supplied with the sample, endometrial cells need not be reported in women less than 40 years. cells need not be reported in women less than 40 years.

Reporting benign appearing exfoliated endometrial Reporting benign appearing exfoliated endometrial cells in a woman over 40 years of agecells in a woman over 40 years of age

General Categorization:General Categorization:• OtherOther

Descriptive Interpretation:Descriptive Interpretation:• “ “Endometrial cells present. -See Comment. “Endometrial cells present. -See Comment. “• ““No evidence of squamous intraepithelial lesion.”(Optional)No evidence of squamous intraepithelial lesion.”(Optional)

Educational note:Educational note:• ““Endometrial cells after age 40, particularly out of phase or Endometrial cells after age 40, particularly out of phase or

after menopause, may be associated with benign after menopause, may be associated with benign endometrium, hormonal alterations and less commonly, endometrium, hormonal alterations and less commonly, endometrial/ uterine abnormalities. Clinical correlation is endometrial/ uterine abnormalities. Clinical correlation is recommended.”recommended.”

Hormonal EvaluationHormonal Evaluation• Recommendation:Recommendation:

Delete this category in the Bethesda System. Delete this category in the Bethesda System.