BETHESDA CLASSIFICATION


Dates back to 1991

I. Benign cellular changes

  1. Infection (trich, fungi, BV, HSV, etc.)
  2. Reactive changes (associated inflammation, atrophy, IUD, etc.)

II. Epithelial cell information

  1. Squamous cell evaluation: four possible classifications
  1. ASCUS:
  1. Refers to squamous cell abnormalities not attributable to reactive changes alone, but not characteristic of an SIL (i.e. if a specific cause, like trich, can be identified, won't be reported as ASCUS).
  2. Should say whether reactive or neoplastic classification is favored; formerly known as "Class II"
  3. 5% of paps; ass'd w/HPV in up to 75% of cases; more common in women under 40
  1. LGSIL: includes former categories of "mild dysplasia," "Class III," CIN I, "HPV changes."
  1. Usually goes back to normal without treatment, some will go on to precancerous lesions. About 20% will be found to have CIN II or CIN III on colpo-directed bx.
  1. HGSIL: includes former categories of "moderate/severe dysplasia," CIN 2, CIN 3, CIS
  2. Squamous cell carcinoma (72% of all cervical Ca)
  1. Glandular cell evaluation
  1. Endocervical cells (benign)
  2. Endometrial cells: normal in first half of menstrual cycle, but their presence in second half of menstrual cycle or in a smear from a postmenopausal pt is abnormal (ass'd w/adenocarcinoma in approx. 10% of cases!)
  3. Atypical glandular cells of undetermined significance: should say whether reactive or neoplastic classification is favored
  4. Endocervical or endometrial adenocarcinoma
  1. Other cancers
  2. Hormonal evaluation (on vaginal cells)