PART TWO
Diagnostic Cytology
Concluding Remarks
Cervical cytology has seen many changes since its introduction
in the 1960s—liquid-based sampling techniques, automated
preparation, computer-assisted screening, HPV DNA testing,
and more recently dual testing, which combines cytology screen-
ing with HPV testing. HPV vaccines entered the market in 2006,
and are likely to further decrease the incidence of invasive squa-
mous cell carcinoma of the cervix and its precursor lesions.
Cervical cancer screening guidelines have undergone significant
changes after implementation of LBP and HPV testing and with
advances in the understanding of cervical neoplasia.80 It is pre-
dicted that the number of cervical cytology tests performed will
decrease significantly in the future if there is compliance with
these guidelines.81
The Bethesda System has met the goals that were conceived
at the time of its implementation in 1988. It has seen successful
penetration into cervical cytology reporting worldwide, allow-
ing laboratories to use consistent terminology in conveying
results to clinicians and thus enabling comparison of studies
across many countries and health care systems. The use of the
Bethesda ASC-US terminology prompted the NCI-sponsored
ALTS trial, the results of which have significantly impacted the
management of equivocal and low-grade cervical cytologic
abnormalities. The Bethesda terminology has been updated
twice—in 1991 and 2001 since its inception in 1988 in order
to keep pace with the advances in our understanding of cervi-
cal cancer and evolving technologies in cervical cancer screening
and prevention. The Bethesda System also provided the basis for
the ASCCP to develop consensus guidelines for management of
cervical cytologic abnormalities as defined by TBS. This proc-
ess of re-evaluation and revision will continue in the future in
order to provide the most accurate, reproducible, and relevant
terminology. Optimal communication and ultimately patient
care outcomes will therefore ensue.
References
1.
National Cancer Institute Workshop. The
1988 Bethesda System for reporting cervi-
cal/vaginal cytologic diagnoses.
JAMA
1989;262:931-934.
2.
National Cancer Institute Workshop. The
Bethesda System for reporting cervical/
vaginal cytologic diagnoses.
Acta Cytol
1993;37:115-124.
3.
Kurman RJ, Solomon D.
The Bethesda
System for Reporting Cervical/Vaginal
Cytologic Diagnoses: Definitions, Criteria
and Explanatory Notes for Terminology and
Specimen Adequacy.
New York: Springer-
Verlag, 1994.
4.
Davey D, Woodhouse S, Styer P, et al.
Atypical epithelial cells and specimen
adequacy: current laboratory practices of
the participants in the College of Ameri-
can Pathologists interlaboratory compari-
son program in cervicovaginal cytology.
Arch Pathol Lab Med
2000;124:203-211.
5.
ASCUS LSIL Triage Study (ALTS) Group.
Results of a randomized trial on
management of cytology interpretations
of atypical squamous cells of undeter-
mined significance.
Am J Obstet Gynecol
2003;188:1383-1392.
6.
Schiffman M, Adrianza ME. ASCUS-LSIL
Triage Study. Design, methods and char-
acteristics of trial participants.
Acta Cytol
2000;44(5):726-742.
7.
Solomon D, Davey D, Kurman R, et al.
for the Forum Group Members and the
Bethesda 2001 Workshop. The 2001
Bethesda System—terminology for
reporting results of cervical cytology.
JAMA
2002;287:2114-2119.
8.
Wright TC Jr, Cox JT, Massad LS, et al.
ASCCP-Sponsored Consensus Con-
ference. 2001 Consensus Guidelines
for the management of women with
cervical cytological abnormalities.
JAMA
2002;287:2120-2129.
9.
ASCCP consensus guidelines. Am J Obstet
Gynecol 2007; 197(4):346-355.
10. Solomon D, Nayar R (eds)
The Bethesda
System for Reporting Cervical Cytology
, 2nd
edn. New York: Springer, 2004.
11. Bethesda System Web Atlas. Available at
the American Society of Cytopathology
website: http://www. cytopathology.org
12. Sherman ME, DasGupta A, Schiffman M,
et al. Bethesda Interobserver Reproduc-
ibility Study (BIRST).
Cancer Cytopathol
2007;111:15-25.
13. Bottles K, Reiter RC, Steiner AL, et al.
Problems encountered with The Bethesda
System: The University of Iowa experi-
ence.
Obstet Gynecol
1991;78:410-414.
14. Kline TS, Solomon D. Guidelines for
specimen adequacy: A plea for workable
definitions.
Diagn Cytopathol
1991;7:1-2.
15. Solomon D, Henry M. Specimen adequacy.
In: Wied GL, Keebler CM, Rosenthal DL, et
al (eds)
Compendium on Quality Assurance,
Proficiency Testing and Workload Limitations
in Clinical Cytology
. Chicago: Tutorials of
Cytology, 1995: 90-94.
16. Birdsong G. Pap smear adequacy: is our
understanding satisfactory .
.. or limited?
Diagn Cytopathol
2001;24:79-81.
17. Studeman KD, Ioffe OB, Puszkiewicz J,
et al. Effect of cellularity on the sensitiv-
ity of detecting squamous lesions in
liquid-based cervical cytology.
Acta Cytol
2003;47(4):605-610.
18. Bolick DR, Kerr J, Stanely BE, et al. Effect
of cellularity in the detection rates of high
grade and low grade squamous intraepi-
thelial lesions.
Acta Cytol
2002;46:922-
923 (abstract).
19. Bos AB, van Ballegooijen M, van den
Akker-van Marle E, et al. Endocervical
status is not predictive of the incidence of
cervical cancer in the years after negative
smears.
Am J Clin Pathol
2001;115:851-855.
20. Elias A, Linthorst G, Bekker B, et al. The
significance of endocervical cells in the
diagnosis of cervical epithelial changes.
Acta Cytol
1983;27:225-229.
21. Mauney M, Eide D, Sotham J.
Rates of condyloma and dysplasia in
Papanicolaou smears with and
without endocervical cells.
Diagn
Cytopathol
1990;6:18-21.
22. Mitchell H, Medley G. Influence of
endocervical status on the cytologic
prediction of cervical intraepithelial neo-
plasia.
Acta Cytol
1992;36:875-880.
23. Mitchell H, Medley G. Longitudinal study
of women with negative cervical smears
according to endocervical status.
Lancet
1991;337:265-268.
24. Mitchell HS. Longitudinal analysis
of histologic high grade disease after
negative cervical cytology according to
endocervical status.
Cancer Cytopathol
2001;93:237-240.
25. Smith HO, Tiffany MF, Qualls CR, et al.
The rising incidence adenocarcinoma
relative to squamous cell carcinoma of
the uterine cervix in the United States:
a 24-year population based study.
Gynecol Oncol
2000;108:397.
26. zheng T, Holford TR, Ma Z, et al. The
continuing increase in adenocarcinoma
of the uterine cervix: a birth control
phenomenon.
Int J Epidemiol
1996;25:252-258.
27. Ransdell JS, Davey DD, Zaleski S,
et al. Clinicopathologic correlation of
the unsatisfactory Pap smear.
Cancer
Cytopathol
1997;81:139-143.
28. Davey D, Austin M, Birdsong G, et al.
ASCCP patient management guidelines:
Pap test adequacy and quality indicators.
J Low Genit Tract Dis
2002;6:195-199.
29. Nielsen ML, Davey DD, Kline TS.
Specimen adequacy evaluation in
gynecologic cytopathology.
Diagn
Cytopathol
1993;9:394-403.
30. Davey DD, Woodhouse S, Styer P, et al.
Atypical epithelial cells and specimen
adequacy.
Arch Pathol Lab Med
2000;124(2):203-211.
88
previous page 90 ComprehensiveCytopathology 1104p 2008 read online next page 92 ComprehensiveCytopathology 1104p 2008 read online Home Toggle text on/off