Terminology and categories for reporting cervical smears

Historical perspective: it is widely acknowledged that the criteria and terminology used to interpret and report cervical smears differs country to country. This has led to problems of communication between cytopathologists, cytotechnologists and clinicians and makes it difficult for epidemiologists to make valid comparisons of the effectiveness of the different cervical screening programmes. The variability in terminology impedes meaningful discussion between laboratories and also affects patient management and the introduction of optimal methods of patient care.
The problem was addressed in 1988, by the National Cancer Institute in the United States who prepared a reporting system for cervical cytology which is known as The Bethesda System (TBS). In1990, the Leonardo da Vinci programme sponsored the preparation of the Equivalent Terminology Tables which compared the many systems of reporting cervical smears in the European Union with the Bethesda system. See Equivalent Terminology
The partners involved in the preparation of Eurocytology website have opted to use the terminology proposed in The Bethesda System in view of its world wide application. Wherever appropriate links to the Equivalent Terminology have been maintained.

The main categories of the Bethesda reporting system (2001) are shown below:

SPECIMEN TYPE
2001 Bethesda System	Equivalent Terminology
Indicate whether conventional smear, endocervical brush specimen or liquid based cytology (LBC) specimen	Indicate whether conventional smear, endocervical brush specimen or liquid based cytology (LBC) specimen

SPECIMEN ADEQUACY
2001 Bethesda System	Equivalent Terminology
Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and other quality indicators e.g. partially obscuring blood etc)	Satisfactory for evaluation Satisfactory for evaluation but limited by (specify reason)
Specimen rejected/not processed (specify reason)	Unsatisfactory for evaluation (specify reason)
Specimen process and examined but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)

GENERAL CATEGORISATION (optional)
2001 Bethesda System	Equivalent Terminology
Negative for intraepithelial lesion
Other: see Interpretation/Results
Epithelial Cell Abnormality (specify Squamous or Glandular as appropriate)

INTERPRETATION / RESULTS
2001 Bethesda System	Equivalent Terminology
Negative for intraepithelial lesion or malignancy	Negative
	Within normal limits
	Benign cellular changes

ORGANISMS DETECTED
2001 Bethesda System	Equivalent Terminology
Trichomonas vaginalis	Trichomonas vaginalis
Fungal organisms morphologically consistent with Candida spp	Candida spp
Shift in flora suggestive of bacterial vaginosis	Coccobacilli
Bacteria morphologically consistent with Actinomyces spp	Actinomyces spp
Cellular changes consistent with herpes simplex virus infection	Cellular changes indicate Herpes simplex virus infection

OTHER NON NEOPLASTIC FINDINGS (optional; list not inclusive)
2001 Bethesda System	Equivalent Terminology
Reactive cellular changes associated with inflammation /repair	Reactive cellular changes associated with inflammation /repair
Radiation	Radiation
Intrauterine contraceptive device	Intrauterine contraceptive device
Glandular cell status post hysterectomy	Endometrial cells in a post menopausal woman
Endometrial cells (in a woman >40year if age)	Glandular cell inconsistent with stated age and/ clinical status of woman

SQUAMOUS EPITHELIAL CELL ABNORMALITIES
2001 Bethesda System	Equivalent Terminology
Atypical squamous cells of undetermined significance (ASC-US) cannot exclude HSIL (ASC-H)	Borderline nuclear changes
Low grade Squamous intraepithelial lesions (LSIL) encompassing: HPV/mild dysplasia/CIN1	Mild dysplasia/CIN1 with or without HPV Mild dyskariosis suggestive of CIN1(with or without HPV)
High grade Squamous intraepithelial lesion (HSIL) encompassing: moderate and severe dysplasia, CIS, CIN2 and CIN3	Moderate dysplasia/ CIN2 Moderate dyskariosis suggestive of CIN2 Severe dysplasia/ CIS/ CIN3 Severe dyskariosis suggestive of CIN3
With features suspicious for invasion	Severe dysplasia/ ?invasive carcinoma Severe dyskariosis/ ?invasive carcinoma Suggests CIN3 but invasive carcinoma not excluded
Squamous cell carcinoma	Invasive Squamous cell carcinoma

GLANDULAR EPITHELIAL ABNORMALITIES
2001 Bethesda System	Equivalent Terminology
Atypical Endocervical cells (NOS or specify) Endometrial cells (NOS or specify) Glandular cells (NOS or specify)	Atypical glandular cells (NOS or specify type) Atypical glandular cells of uncertain significance ? glandular neoplasia
Atypical Endocervical cells (favour neoplastic) Glandular cells (favour neoplastic)
Endocervical adenocarcinoma in situ	Endocervical adenocarcinoma in situ Suggest adenocarcinoma in situ,invasive adenocarcinoma not excluded ?glandular neoplasia
Adenocarcinoma Endocervical Endometrial Extrauterine Not otherwise specified (NOS)	Adenocarcinoma Endocervical Endometrial Extrauterine Not otherwise specified (NOS)

IARC Handbooks of Cancer Prevention

Volume 10 Cervix Cancer Screening
Chapter 2: pp 59-67 historical revue of terminology used to describe cervical smears
Chapter 2: pp 69-74 comparison of conventional cytology with liquid based cytology