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
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
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
* 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
* 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).
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.
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.
|Remember we are NOT Doctors and have NO medical training.|
This site is like an Encyclopedia - there are many pages, many links on many topics.
Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.