Bethesda System
Encyclopedia
The Bethesda System is a system for reporting cervical
or vaginal cytologic
diagnoses, used for reporting Pap smear
results. It was introduced in 1988, and revised in 1991 and 2001. The name comes from the location (Bethesda, Maryland
) of the conference that established the system.
. LSIL usually indicates mild dysplasia (CIN 1), more than likely caused by a human papillomavirus
infection. It is usually diagnosed following a Pap smear
.
CIN 1 is the most common and most benign form of cervical intraepithelial neoplasia and usually resolves spontaneously within two years. Because of this, LSIL results can be managed with a simple "watch and wait" philosophy. However, because there is a 12-16% chance of progression to more severe dysplasia, the physician may want to follow the results more aggressively by performing a colposcopy
with biopsy
. If the dysplasia progresses, treatment may be necessary. Treatment involves removal of the affected tissue, which can be accomplished by LEEP
, cryosurgery
, cone biopsy, or laser ablation.
or carcinoma in situ
. It is usually diagnosed following a Pap test. In some cases these lesions can lead to invasive cervical cancer
, if not followed appropriately.
HSIL does not mean that cancer is present. Of all women with HSIL results, 2% or less have invasive cervical cancer at that time, however about 20% would progress to having invasive cervical cancer without treatment. To combat this progression, HSIL is usually followed by an immediate colposcopy
with biopsy
to sample or remove the dysplastic tissue. This tissue is sent for pathology
testing to assign a histologic
classification that is more definitive than a Pap smear result (which is a cytologic
finding). HSIL generally corresponds to the histological classification of CIN 2 or 3
.
HSIL treatment involves the removal or destruction of the affected cells, usually by LEEP
. Other methods include cryotherapy
, cautery, or laser ablation, but none are performed on pregnant
women for fear of disrupting the pregnancy. Any of these procedures is 85% likely to cure the problem.
can arise from the endocervix, endometrium and extrauterine sites.
The management of AGC is colposcopy
with or without an endometrial
biopsy
.
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
or vaginal cytologic
Cytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
diagnoses, used for reporting Pap smear
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
results. It was introduced in 1988, and revised in 1991 and 2001. The name comes from the location (Bethesda, Maryland
Bethesda, Maryland
Bethesda is a census designated place in southern Montgomery County, Maryland, United States, just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House , which in turn took its name from Jerusalem's Pool of Bethesda...
) of the conference that established the system.
Types of results
Abnormal results include:- Atypical squamous cells
- Atypical squamous cells of undetermined significance (ASC-US)
- Atypical squamous cells - cannot exclude HSIL (ASC-H)
- Low grade squamous intraepithelial lesion (LGSIL or LSIL)
- High grade squamous intraepithelial lesion (HGSIL or HSIL)
- Squamous cell carcinomaSquamous cell carcinomaSquamous cell carcinoma , occasionally rendered as "squamous-cell carcinoma", is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of malignant cells deriving from epithelium, or showing particular cytological or tissue architectural characteristics of...
- Atypical Glandular Cells not otherwise specified (AGC-NOS)
- Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)
- Adenocarcinoma in situ (AIS)
LSIL - Low-grade Squamous Intraepithelial Lesion
Low grade squamous intraepithelial lesion (LSIL or LGSIL) indicates possible cervical dysplasiaCervical intraepithelial neoplasia
Cervical intraepithelial neoplasia , also known as cervical dysplasia and cervical interstitial neoplasia, is the potentially premalignant transformation and abnormal growth of squamous cells on the surface of the cervix. CIN is not cancer, and is usually curable...
. LSIL usually indicates mild dysplasia (CIN 1), more than likely caused by a human papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...
infection. It is usually diagnosed following a Pap smear
Pap smear
The Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
.
CIN 1 is the most common and most benign form of cervical intraepithelial neoplasia and usually resolves spontaneously within two years. Because of this, LSIL results can be managed with a simple "watch and wait" philosophy. However, because there is a 12-16% chance of progression to more severe dysplasia, the physician may want to follow the results more aggressively by performing a colposcopy
Colposcopy
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
with biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
. If the dysplasia progresses, treatment may be necessary. Treatment involves removal of the affected tissue, which can be accomplished by LEEP
Loop electrical excision procedure
The loop electrosurgical excision procedure is currently one of the most commonly used approaches to treat high grade cervical dysplasia discovered on colposcopic examination. In UK it is known as "large loop excision of the transformation zone" . The procedure has many advantages including low...
, cryosurgery
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
, cone biopsy, or laser ablation.
HSIL - High-grade Squamous Intraepithelial Lesion
High grade squamous intraepithelial lesion (HSIL or HGSIL) indicates moderate or severe cervical intraepithelial neoplasiaCervical intraepithelial neoplasia
Cervical intraepithelial neoplasia , also known as cervical dysplasia and cervical interstitial neoplasia, is the potentially premalignant transformation and abnormal growth of squamous cells on the surface of the cervix. CIN is not cancer, and is usually curable...
or carcinoma in situ
Carcinoma in situ
Carcinoma in situ is an early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue, usually before penetration through the basement membrane. In other words, the neoplastic cells proliferate in their normal habitat, hence the name "in situ"...
. It is usually diagnosed following a Pap test. In some cases these lesions can lead to invasive cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
, if not followed appropriately.
HSIL does not mean that cancer is present. Of all women with HSIL results, 2% or less have invasive cervical cancer at that time, however about 20% would progress to having invasive cervical cancer without treatment. To combat this progression, HSIL is usually followed by an immediate colposcopy
Colposcopy
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
with biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
to sample or remove the dysplastic tissue. This tissue is sent for pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
testing to assign a histologic
Histology
Histology is the study of the microscopic anatomy of cells and tissues of plants and animals. It is performed by examining cells and tissues commonly by sectioning and staining; followed by examination under a light microscope or electron microscope...
classification that is more definitive than a Pap smear result (which is a cytologic
Cytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
finding). HSIL generally corresponds to the histological classification of CIN 2 or 3
Cervical intraepithelial neoplasia
Cervical intraepithelial neoplasia , also known as cervical dysplasia and cervical interstitial neoplasia, is the potentially premalignant transformation and abnormal growth of squamous cells on the surface of the cervix. CIN is not cancer, and is usually curable...
.
HSIL treatment involves the removal or destruction of the affected cells, usually by LEEP
Loop electrical excision procedure
The loop electrosurgical excision procedure is currently one of the most commonly used approaches to treat high grade cervical dysplasia discovered on colposcopic examination. In UK it is known as "large loop excision of the transformation zone" . The procedure has many advantages including low...
. Other methods include cryotherapy
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
, cautery, or laser ablation, but none are performed on pregnant
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
women for fear of disrupting the pregnancy. Any of these procedures is 85% likely to cure the problem.
Adenocarcinoma
AdenocarcinomaAdenocarcinoma
Adenocarcinoma is a cancer of an epithelium that originates in glandular tissue. Epithelial tissue includes, but is not limited to, the surface layer of skin, glands and a variety of other tissue that lines the cavities and organs of the body. Epithelium can be derived embryologically from...
can arise from the endocervix, endometrium and extrauterine sites.
AGC
AGC, formerly AGUS, is an acronym for atypical glandular cells of undetermined significance. Renamed AGC to avoid confusion with ASCUS.The management of AGC is colposcopy
Colposcopy
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination...
with or without an endometrial
Endometrium
-Function:The endometrium is the innermost glandular layer and functions as a lining for the uterus, preventing adhesions between the opposed walls of the myometrium, thereby maintaining the patency of the uterine cavity. During the menstrual cycle or estrous cycle, the endometrium grows to a...
biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
.