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Concept
Bethesda system
Summary
The Bethesda system (TBS), officially called The Bethesda System for Reporting Cervical Cytology, 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, 2001, and 2014. The name comes from the location (Bethesda, Maryland) of the conference, sponsored by the National Institutes of Health, that established the system.
Since 2010, there is also a Bethesda system used for cytopathology of thyroid nodules, which is called The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC or BSRTC). Like TBS, it was the result of a conference sponsored by the NIH and is published in book editions (currently by Springer). Mentions of "the Bethesda system" without further specification usually refer to the cervical system, unless the thyroid context of a discussion is implicit.
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 carcinoma
Atypical Glandular Cells not otherwise specified (AGC-NOS)
Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)
Adenocarcinoma in situ (AIS)
The results are calculated differently following a Pap smear of the cervix.
A low-grade squamous intraepithelial lesion (LSIL or LGSIL) indicates possible cervical dysplasia. 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.
Official source
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