Impact of the Bethesda System.

BACKGROUND Although the Bethesda System provides concise, specific descriptions for classifying cervical cytology, its usefulness has been questioned in the United States and abroad. The author attempted to evaluate the impact of the Bethesda System on cervical screening and subsequent management decisions. METHODS A MedLine search provided statistical information for comparison of screening procedures and results before and since introduction of the Bethesda System. The effect of the Bethesda System was evaluated by specimen adequacy, inclusion of human papillomavirus changes in the squamous intraepithelial lesion (SIL) category, and effect on the number of abnormal Pap smears. RESULTS By 1992, 85% of cytology laboratories were using Bethesda system terminology. Diagnosis and treatment of patients with atypical squamous cells of undetermined significance (ASCUS) and low grade squamous intraepithelial lesions were reviewed. In women with ASCUS smears, follow-up studies showed that between 5% and 13% actually had high grade cervical lesions. For patients with a cytologic diagnosis of low grade SIL, one study found an 18.6% incidence of high grade lesions demonstrated by colposcopically directed cervical biopsy. An estimated 2% increase has occurred in the number of women with abnormal Pap smear results who require additional evaluation costing more than $1 billion. CONCLUSIONS The Bethesda System has improved the quality of Pap smear diagnosis in the United States, but the number of women with abnormal Pap smear results has increased. Although this increase is partly due to the terminology of the Bethesda System, other factors play a role. Whether this has improved cancer prevention is unknown.

[1]  A. Meisels,et al.  Condylomatous lesions of the cervix and vagina. I. Cytologic patterns. , 1976, Acta cytologica.

[2]  M. Spitzer,et al.  Comparative Utility of Repeat Papanicolaou Smears, Cervicography, and Colposcopy in the Evaluation of Atypical Papanicolaou Smears , 1987, Obstetrics and gynecology.

[3]  The Bethesda System for cervical/vaginal cytologic diagnoses: a note of caution. , 1990, Obstetrics and gynecology.

[4]  Jorma Paavonen,et al.  A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. , 1992 .

[5]  M. Schiffman,et al.  An evaluation of human papillomavirus testing as part of referral to colposcopy clinics , 1992, Obstetrics and gynecology.

[6]  R. Newcombe,et al.  Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia. , 1989, BMJ.

[7]  Brown Cl,et al.  The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnoses. , 1990, Acta cytologica.

[8]  Diane Solomon,et al.  The Bethesda System for Reporting Cervical/Vaginal Cytologic Diagnoses , 1994, Springer US.

[9]  B. Monk,et al.  Natural History of the Minimally Abnormal Papanicolaou Smear , 1992, Obstetrics and Gynecology.

[10]  D. Davey,et al.  Specimen adequacy evaluation in gynecologic cytopathology: Current laboratory practice in the college of american pathologists interlaboratory comparison program and tentative guidelines for future practice , 1993, Diagnostic cytopathology.

[11]  D. Davey,et al.  Atypical squamous cells of undetermined significance: Interlaboratory comparison and quality assurance monitors , 1994, Diagnostic Cytopathology.

[12]  D. Solomon The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnoses: developed and approved at the National Cancer Institute Workshop in Bethesda, Maryland, December 12-13, 1988. , 1990, Human pathology.

[13]  R Reid,et al.  Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types. , 1992, Obstetrics and gynecology.

[14]  Diane Soloman,et al.  The 1988 Bethesda system for reporting cervical/vaginal cytologic diagnoses: Developed and approved at the national cancer institute workshop in Bethesda, MD, December 12–13, 1988 , 1989, Diagnostic cytopathology.

[15]  D. Guzick,et al.  Prevalence of papillomarvirus infection in colposcopically directed cervical biopsy specimens in 1972 and 1982. , 1985, American journal of obstetrics and gynecology.