Cervical Cytology Reporting – Classification According to Bethesda System

Glavni namen snovalcev klasifikacije po Bethesdi je bil ustvariti tako terminologijo sprememb na materničnem vratu, da bi bil citološki izvid Pap testa jasen in bi jasno odražal nadaljnjo obravnavo žensk. V Sloveniji smo leta 2006 spremenili klasifikacijo in se zelo približali Bethesdini, sedaj pa smo se odločili, da jo v celoti prevzamemo. Glavne spremembe so naslednje: v novem izvidu je bris uporaben ali neuporaben. Negativni bris delimo na normalen bris in neneoplastične spremembe, ki poleg reaktivnih sprememb iz stare klasifikacije vsebujejo še tubarno metaplazijo, žlezne celice po histerektomiji, endometrijske celice po 40. letu starosti in folikularni cervicitis. Med patološkimi spremembami je na ploščatem epiteliju najpomembnejša razlika ta, da je namesto atipičnih metaplastičnih celic dodana zelo pomembna kategorija atipičnih ploščatih celic, ne moremo pa izključiti ploščatocelične lezije visoke stopnje. Patološke spremembe žleznih celic so razdeljene v 4 skupine. Priporočila v novi klasifikaciji niso več obvezna, saj je odločitev o nadaljnji obravnavi žensk z nekaterimi spremembami odvisna tudi od HPV-testiranja. Obvezni postopki so zapisani v Smernicah za celostno obravnavo žensk s predrakavimi spremembami materničnega vratu.The main goal of Bethesda classification was to develop a system for reporting Pap smears that would communicate the cytology interpretation to the clinician in a clear and relevant fashion. In Slovenia, a new classification, which closely approximated Bethesda classification, was introduced in 2006. In 2011, we decided to fully accept Bethesda clasification. Specimen adequacy is now evaluated as satisfactory or unsatisfactory for evaluation, with the specification why the specimen cannot be examined. If smear is negative for epithelial lesion, it is labeled either as normal smear or non-neoplastic disorder. Pathologic changes are devided into epithelial cell abnormalities: squamous and glandular. Among squamous epithelial cell abnormalities, the most problematic and controversial categories are atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells cannot exclude high-grade sqamous intraepithelial lesion (ASC-H) . Squamous intraepithelial lesions (SIL) in Bethesda system are devided into low-grade intraepithelial lesion (LSIL), high-grade intraepithelial lesion (HSIL) and squamous carcinoma. Glandular cell abnormalities are devided into four categories: atypical glandular cell NOS, atypical glandular cells favour neoplastic, endocervical adenocarcinoma in situ, and adenocarcinoma