2001 Bethesda System-Reporting Pap Abnormalities

A revised system for reporting the results of Pap tests, published in the April 24, 2002, issue of the Journal of the American Medical Association (JAMA)*, will change the way laboratories communicate with physicians about the 50 million cervical cancer screening tests performed each year in the United States.

Known as the 2001 Bethesda System, the reporting system conveys laboratory findings that help physicians and their patients decide what to do about the abnormalities found on Pap tests. The 2001 Bethesda System does not itself include guidelines for managing these abnormalities.

However, it serves as the basis for new management guidelines that appear in a companion article in JAMA.

The guidelines were developed under the sponsorship of the American Society for Colposcopy and Cervical Pathology (ASCCP) in tandem with the 2001 Bethesda System.

Publication of the two papers is considered a milestone in efforts to improve cervical cancer screening. "Together, Bethesda 2001 and the ASCCP guidelines should provide more uniform, evidence-based care of women with cervical abnormalities," said Diane Solomon, M.D., who has coordinated development of The Bethesda System at the National Cancer Institute.

Bethesda 2001 updates the earlier Bethesda System, first published in 1989 and revised in 1991. The 2001 version reflects the most current knowledge about the biology of Pap test abnormalities and addresses new screening technologies that appeared in the past decade.

Key changes include:

* Sample adequacy : The Bethesda System has always required laboratories to evaluate the adequacy of cervical cell samples based on a standard set of criteria. The 2001 Bethesda System incorporates criteria that are specific to the new thin-layer, or liquid-based, cell collection method now used by many doctors.

* New term (ASC-H) to denote atypical cells at higher-risk of association with precancer : The older Bethesda System grouped all cells considered equivocal -- atypical but not clearly precancerous -- into one category known as atypical squamous cells of undetermined significance or ASCUS. Bethesda 2001 adds a new category for atypical cells at higher risk of association with precancer: "atypical squamous cells - cannot exclude a high-grade lesion" or "ASC-H." By highlighting such cases, the new system should help physicians detect and treat precancerous lesions more rapidly.

In addition, the term "atypical squamous cells favor reactive" has been eliminated in order to focus attention on women at higher risk of having an abnormality.

* Benign Cellular Changes identified as "negative" : The previous version of Bethesda included a category of "benign cellular changes" to communicate findings due to a variety of factors (e.g. inflammation).

However, this approach caused confusion at times for clinicians who questioned whether this term indicated negative results or the need for follow-up. Now such benign changes are more clearly identified as "negative."

In other changes, Bethesda 2001 recommends that laboratories report the use of computerized scanning of Pap test slides and the results of molecular testing (such as tests for the human papillomavirus).

The 2001 Bethesda System is the product of a workshop, sponsored by NCI and numerous professional societies, which took place April 30 - May 2, 2001, in Bethesda, Md. The workshop included more than 400 participants.

Even broader participation in the revision process was made possible through a dedicated Web site , where more than 1,000 individual comments were received on the draft recommendations.

More than 90 percent of laboratories in the United States use The Bethesda System, as do laboratories in many other countries. To date, more than 20 national and international societies have endorsed Bethesda 2001. ----------------------------

* Solomon D, et al, The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology, Journal of the American Medical Association, April 24, 2002, Vol. 287, No. 16, 2114-2119. ###

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