Laboratory Medicine Updates - February 26, 2002
University of Virginia Health
“Quality You Expect, Service You Deserve”
LABORATORY MEDICINE UPDATE
February 26, 2002
The UVA Cytology Laboratory is converting to the 2001 version of the Bethesda System (TBS) for reporting cervical/vaginal interpretations and is providing this overview of the changes in the system to all individuals submitting Pap specimens to the laboratory. The expected conversion date is the evening of February 27, 2002. All Cytopathology Final Reports for Pap tests issued AFTER that date will use the new terminology and the new reporting format. An example of the new format appears at the end of this document.
CONVERSION TO BETHESDA 2001
In 1988 the Division of Cancer Prevention and Control at the National Cancer Institute convened a workshop of experts and consultants to review the then existing terminology for reporting of cervical/vaginal interpretations of gynecologic Pap smears. The result of this workshop was the Bethesda System for the uniform reporting of cervical and vaginal specimen interpretations. Some minor revisions and clarifications to the system were instituted after a second workshop in 1993.
In May 2001, the 2001 Bethesda Conference assembled a large body of pathologists, cytotechnologists, clinicians, nurses, and other interested parties worldwide to review the application of TBS over the previous ten years and to make suggestions for improvements in the system. After much discussion and debate, significant revisions were made in the reporting terminology in an attempt to facilitate appropriate patient management.
The patient report should state the type of specimen submitted to the laboratory (conventional Pap smear or a liquid-based preparation [ThinPrep or Autocyte] or other).
STATEMENT OF ADEQUACY:
Specimens will be designated either satisfactory or unsatisfactory for interpretation. The “limited by” designation has been removed from TBS. However, quality indicators that may hamper or limit the interpretation of “satisfactory” specimens will be listed in the statement of adequacy (e.g., lack of endocervical/transformation zone component, partially obscuring blood or inflammation, etc.).
For specimens determined to be unsatisfactory for evaluation, the statement of adequacy becomes the final interpretation. The reason(s) for the unsatisfactory result is always stated in the report.
One of the most significant changes with TBS 2001 is in the reporting of normal or benign findings. The previous categories of “Within Normal Limits” and “Benign Cellular Changes” have been combined under the single heading of NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY. The presence of infectious organisms (e.g., Trichomonas, Herpes, Candida, etc.) will be indicated, as appropriate, with this interpretation. Other non-neoplastic findings (benign cellular changes) are considered optional and, when reported, will be listed under the heading of “Additional Findings” in the final report.
The presence of endometrial cells outside of menses in women 40 years of age and older will be reported separately from the “Negative” category. This interpretation will also state if the specimen is “negative for squamous intraepithelial lesion.”
The equivocal interpretation categories (ASCUS and AGUS) have also undergone revision. The “favor benign process” designation has been eliminated for both the ASCUS and AGUS groups. The label “atypical cells” should be limited to only those cases of uncertain neoplastic potential as listed below.
Atypical squamous cells
· cannot exclude a high grade intraepithelial lesion
Atypical glandular cells
· atypical endocervical cells (NOS or specify in comments)
· atypical endometrial cells (NOS or specify in comments)
· atypical glandular cells (NOS or specify in comments)
· atypical endocervical cells, favor neoplastic
· atypical glandular cells, favor neoplastic
The reporting of clearly defined epithelial abnormalities (intraepithelial lesions and malignancies) remains unchanged in TBS 2001. Endocervical adenocarcinoma in situ is reported as a distinct entity (as it has always been reported at UVA). Whenever possible, an interpretation of adenocarcinoma should indicate the site of origin (endocervical, endometrial, extrauterine, NOS).
EDUCATIONAL NOTES AND SUGGESTIONS:
Educational notes and suggestions are optional. Suggestions should be concise and consistent with clinical follow-up guidelines published by professional organizations. http://www.asccp.org
The results of any ancillary testing performed on the specimen will be given either in the final report or as an addendum to that report. The results will provide a brief description of the test method and the test outcome so that clinicians can easily understand them.
The full Table of the final Bethesda 2001 Terminology is available at the Web site
http://bethesda2001.cancer.gov. Select the “Final 2001 terminology” button from the left menu. A PDF version is available for downloading the table. The manuscript of explanatory text for Bethesda 2001 is in progress and should be published this year.
UVA FINAL REPORT:
The Cytology Laboratory is reformatting the final reports for Pap specimens to accommodate 2001TBS. All cytologic findings (morphologic interpretation, statement of adequacy, additional findings, suggestions) will be reported under the single header “Final Cytologic Interpretation” with the morphologic interpretation given in bold print. This will give the clinician all of the necessary results information in a single field. The note field will be reserved for any detailed descriptions or observations that the pathologist may choose to make.
If you have any questions or need additional information, please contact the Cytology Laboratory at (434) 924-2779 or 2770.