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The Bethesda system (TBS) 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.
Contents
- Types of results
- LSIL low grade squamous intraepithelial lesion
- HSIL high grade squamous intraepithelial lesion
- Adenocarcinoma
- AGC
- References
Additionally, the Bethesda System is used for thyroid cytopathology.
Types of results
Abnormal results include:
The results are calculated differently following fine needle aspiration of thyroid nodules.
LSIL: low-grade squamous intraepithelial lesion
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. 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.
HSIL: high-grade squamous intraepithelial lesion
High-grade squamous intraepithelial lesion (HSIL or HGSIL) indicates moderate or severe cervical intraepithelial neoplasia 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.
Adenocarcinoma
Adenocarcinoma 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 with or without an endometrial biopsy.
