Correlation of fine needle aspiration cytology and cell block study of category III, IV, and V (TBSRTC-2017) thyroid lesions with special reference to cytokeratin-19 immunohistochemical staining

Context: Ascertaining the role of cytokeratin-19 (CK19) and its staining pattern helps to differentiate papillary carcinoma from other thyroid lesions. Aims: To correlate fine needle aspiration cytology (FNAC) and cell block study of equivocal cases (Category III, IV, and V) with the role of CK19 staining in it. Settings and Design: A hospital-based cross-sectional observational study was designed and conducted at North Bengal Medical College and Hospital, Shusrutnagar, Darjeeling. Methods and Material: The FNAC performed and reported as per TBSRTC-2017.50 cases of Category III, IV, and V was selected for cell block study and CK19 staining followed by immunohistochemical scoring. Results: Out of 50 cases, 17 were follicular neoplasm, 21 papillary carcinoma, 6 lymphocytic thyroiditis, 1 Hürthle cell adenoma, 1 medullary carcinoma, 1 lymphoma, and 3 undifferentiated carcinomas. Among cases of papillary carcinoma, 10 showed 4+ positivity, 9 showed 3+ positivity, 2 showed focal 1+ and 2+ positivity. In the case of follicular neoplasm, 1 showed 3+ positivity, 3 cases had 1+ 2+ positivity, and 13 cases revealed negative staining. Conclusion: Role of CK19 in distinguishing papillary carcinoma of thyroid from other lesions in cytologically diagnosed Category III, IV, and V (TBSRTC-2017) cases can be demonstrated.

Study of cytomorphological features of thyroid lesions and its correlation with thyroid function tests.

Background: Fine needle aspiration cytology along with ultrasound and assessment of thyroid function status remains the mainstay of evaluation of thyroid swellings. According to the guidelines put forth by American Thyroid Association, serum estimation of TSH should be part of initial assessment of thyroid swellings. Present study aims to assess the cytomorphological features of various thyroid lesions, classify them in different categories based on The Bethesda System of Reporting Thyroid Cytology and correlate them with thyroid hormone status of patients. Methods: 165 cases of thyroid lesions were subjected to FNAC, smears were categorised according to The Bethesda System of Reporting Thyroid Cytopathology and cases were also assessed for T3, T4, TSH hormone levels. Results: On interpretation of FNAC non-neoplastic lesions outnumbered the neoplastic lesions and Colloid goitre accounted for the majority of the cases (40.6%). Among the neoplastic lesions, follicular neoplasms were most common. Cytologically majority of the lesions belonged to category II (benign) as per the Bethesda System. On evaluation of thyroid function majority of the cases (69.1%) were euthyroid and were interpreted as either colloid goitre or adenomatoid nodule, whereas most patients of lymphocytic thyroiditis presented with either hypo or hyperthyroidism. Majority of malignant cases also turned out to be hypothyroid (9/12 Cases). None of the malignant case presented with hyperthyroidism. Conclusions: Thyroid cytology proves to be a reliable, simple and cost-effective first line diagnostic procedure. FNAC together with thyroid function test can be used for early and accurate diagnosis of various thyroid lesions, and reduces unnecessary intervention.

Cytomorphological Study of Thyroid Lesions Using the Bethesda System for Reporting Thyroid Cytology and Its Correlation with Thyroid Function Test.

Fine-needle aspiration cytology of thyroid is a simple, minimally invasive, cost effective, readily available, reliable, time saving and an easy to perform outpatient procedure.1 The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is a six category scheme of thyroid cytopathology reporting.2 FNAC in conjunction with thyroid hormonal profile helps in assessing stage of the disease as hyperthyroid, hypothyroid or euthyroid3. It is very helpful in deciding the treatment options for the patient.METHODSThis is a prospective study of 125 fine needle aspirations (FNA) of thyroid nodules. All fine needle aspiration cytology (FNAC) diagnosis were classified according to age and gender, cytological findings and TBSRTC categories. All TBSRTC categories were correlated with thyroid function test results.RESULTSThe distribution of various categories from 125 evaluated thyroid nodules was as follows: 6.4% Non-Diagnostic or Unsatisfactory (ND/UNS), 80% benign, 2.4% Atypia of Undetermined Significance or Follicular Lesion of Undetermined Significance (AUS/FLUS), 4% Follicular Neoplasm (FN), 4% Suspicious for Malignancy (SFM), and 3.2% Malignant. Maximum cases with altered TFT were found in category II. Whereas in category V (5/5) & in category VI (4/4), all cases were euthyroid & not a single case of altered Thyroid Function Test (TFT) was found. Among the 16 cases of thyroiditis, majority of the cases was hypothyroid.CONCLUSIONSTBSRTC is an excellent reporting system for thyroid FNA. It also provides clear management guidelines to clinicians to go for follow-up FNAC or surgery. Diagnostic challenges arise when aspirate samples are quantitatively or qualitatively suboptimal and, in such situations, clinical and TFT correlations are immensely helpful. Alteration in thyroid function tests is associated with benign conditions mostly in thyroiditis in which hypothyroid state can aid in the diagnosis of the benign lesions.

The spectrum of thyroid lesions on fine needle aspiration cytology

Background: Fine Needle Aspiration Cytology (FNAC) of thyroid gland is the most common preoperative investigation for diagnosis of thyroid lesions. Though various tests like thyroid profile, ultrasonography and radionuclide scan are available, they are used as adjuvant diagnostic modalities. FNAC is simple, easy to perform, non-invasive and cost-effective procedure. Primary aim is to study the spectrum of various thyroid lesions on FNAC. Also, the study is aimed to categorise the thyroid lesions according to the Bethesda system for Reporting Thyroid Cytopathology (2017).Methods: This is a retrospective observational study carried out in the pathology department at tertiary care academic institute for a period of three years. FNAC was done in a patient with thyroid swelling by non-aspiration technique. Slides were prepared, fixed in 95% ethyl alcohol and processed with routine stains.Results: Out of 210 cases, 150 cases (71.42%) were benign lesions, 15 cases (7.14%) were Follicular neoplasm/Suspicious for follicular neoplasm, 14(6.66%) cases were reported as Atypia of undetermined significance, 13 cases (6.19%) were Unsatisfactory/Nondiagnostic, 11 cases (5.2%) were malignant and 7 cases (3.3%) were suspicious for malignancy.Conclusions: FNAC is the most effective tool for the diagnosis of thyroid lesions. The Bethesda system is used to categorise the thyroid lesions and helps in better communication between clinicians and pathologists for the best surgical and medical management. The number of benign cases were higher and the number of cases in the category of suspicious for malignancy were lower with female preponderance.

A study of cervical cytology in females above 21 years of age

Background: Cancer cervix is the leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities or due to the lack of awareness amongst the women of developing countries. Worldwide, cervical cancer is the second most common and 5th deadliest cancer in women. This study was conducted in department of obstetrics and Gynaecology, Umaid hospital, Dr. S. N. Medical College, Jodhpur Rajasthan, India. The objective of this study was to study the various high risk factors involved in premalignant and malignant lesions of cervix. To study the incidence of different epithelial abnormalities of cervix in females above 21 years of age. To study premalignant and malignant lesions of the cervix in relation to the presenting complaintMethods: The study was conducted in 500 females above 21 years of age and who were not pregnant, who had been attending Umaid Hospital, Jodhpur for various gynaecological complaints, of different parity, residential status and socioeconomic class. Detailed history was taken and thorough examination was done. Pap smear was prepared and all smears were reported as per the Bethesda system.Results: Maximum numbers of patients were in the age group of 21-40 years (70.2%). Majority of patients were from rural area (52.4%) and from lower socioeconomic class (30.2%). Most of women were found to have duration of marriage between 10 to 30 years (63.4%). Most of the women in our study had age at marriage between 17 to 19 years (49.4%). Multiparity was seen in 84.2% of cases. The commonest presenting complaint was white discharge (46.8%). On Pap smear, maximum cases were of inflammatory smear (91.4%), 1.4% had ASCUS, 1.2% AGC, 1.4% LSIL, 1% HSIL and 0.4% had SCC.Conclusions: Cervical cytology is an important tool for early detection of premalignant and malignant lesions of cervix. Regular pap smear screening should be conducted in vulnerable age groups.

Study on the relationship between thyroid imaging reporting and data system and the Bethesda system for reporting thyroid cytopathology / 中国医师进修杂志

Objective To compare effect between thyroid imaging reporting and data system (TI-RADS) and the Bethesda system for reporting thyroid cytopathology (TBSRTC) in the qualitative diagnosis of thyroid nodule. Methods The clinical data of 665 patients with thyroid nodule (1 598 nodules) from April 2013 to October 2016 were retrospectively analyzed. TBSRTC and TI-RADS were used for qualitative diagnosis of thyroid nodule before operation. Pathological diagnosis was performed after the operation. The diagnostic effect of TI-RADS and TBSRTC were assessed, and the factors leading to the diagnostic errors were analyzed. Results Of 1 598 thyroid nodules, the pathological diagnosis showed that benign nodules were in 202, and malignant thyroid nodules were in 1 396. The diagnostic sensitivity and 85.64%(173/202) vs. 74.75%(151/202) and specificity of malignant nodules by TBSRTC were significantly higher than that by TI-RADS: 91.76% (1 281/1 396) vs. 87.11% (1 216/1 396), and there was statistical difference (P＜0.01). The diagnosis positive rate of malignant nodules with diameter＜1 cm by TBSRTC was significantly higher than that by TI-RADS: 77.63% (59/76) vs. 47.37% (36/76), and there was statistical difference (P＜0.01); there was no statistical difference in diagnosis positive rate of malignant nodules with diameter ≥ 1 cm between 2 methods (P＞0.05). Univariate analysis result showed that the diameter of thyroid nodules in patients with TI-RADS false negative was significantly smaller than that in patients with benign thyroid nodules: (1.01 ± 0.48) cm vs. (1.51 ± 0.45) cm, the incidence of malignant thyroid nodules combined with other thyroid diseases was significantly higher than that in patients with benign thyroid nodules: 41.18% (21/51) vs. 11.32% (158/1 396), and there were statistical differences (P＜0.05); the rate of thyroid dysfunction in patients with TBSRTC false positive was significantly higher than that in patients with malignant thyroid nodules: 18.26% (21/115) vs. 6.93% (14/202), and there was statistical difference (P＜0.05). Conclusions The qualitative diagnosis of thyroid nodule requires the cross-reference of TI-RADS and TBSRTC, and the combination of other clinical indicators of patients can improve the detection rate of malignant thyroid nodules.

Thyroid Cytology in India: Contemporary Review and Meta-analysis

Fine-needle aspiration cytology (FNAC) is a screening test for triaging thyroid nodules, aiding in subsequent clinical management. However, the advantages have been overshadowed by the multiplicity of reporting systems and a wide range of nomenclature used. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was formulated in 2007, to give the world a uniform thyroid cytology reporting system, facilitating easy interpretation by the clinicians. Here, we review the status of thyroid FNAC in India in terms of various reporting systems used including a meta-analysis of the previously published data. An extensive literature search was performed using internet search engines. The reports with detailed classification system used in thyroid cytology were included. The meta-analysis of published data was compared with the implied risk of malignancy by TBSRTC. More than 50 studies were retrieved and evaluated. TBSRTC is currently the most widely used reporting system with different studies showing good efficacy and interobserver concordance. Ancillary techniques have, as of now, limited applicability and acceptability in thyroid cytology in India. Twenty-eight published articles met the criteria for inclusion in the meta-analysis. When compared with TBSRTC recommendations, the meta-analysis showed a higher risk of malignancy for categories I and III. Thyroid FNAC is practiced all over India. TBSRTC has found widespread acceptance, with most institutions using this system for routine thyroid cytology reporting. However, reasons for a high malignancy risk for categories I and III need to be looked into. Various possible contributing factors are discussed in the review.

Thyroid Cytology: The Japanese System and Experience at Yamashita Thyroid Hospital

In Japan, fine-needle aspiration (FNA) cytology is the most important diagnostic modality for triaging patients with thyroid nodules. A clinician (endocrinologist, endocrine surgeon, or head and neck surgeon) generally performs FNA cytology at the outpatient clinic, and ultrasound (US)-guided FNA is widespread because US is extremely common and most clinicians are familiar with it. Although almost all FNA thyroid samples are examined by certified cytopathologists and pathologists, some clinicians assess cytological specimens themselves. In Japan, there are two clinical guidelines regarding the management of thyroid nodules. One is the General Rules for the Description of Thyroid Cancer (GRDTC) published by the Japanese Society of Thyroid Surgery (JSTS) in 2005, and the other is the national reporting system for thyroid FNA cytology published by the Japan Thyroid Association in 2013 (Japanese system). Although the Bethesda System for Reporting Thyroid Cytopathology (Bethesda system) is rarely used in Japan, both the GRDTC and Japanese system tried to incorporate the Bethesda system so that the cytological diagnoses would be compatible with each other. The essential point of the Japanese system is stratification of follicular neoplasm (FN) into three subgroups based on cytological features in order to reduce unnecessary diagnostic thyroidectomy, and this system has been successful in stratifying the risk of malignancy in FN patients at several high-volume thyroid surgery centers. In Japan, the measurement of thyroglobulin and/or calcitonin in FNA needle washings is often used as an adjunct for diagnosis of possible cervical lymph node metastasis when FNA cytology is performed.

Thyroid Fine-Needle Aspiration Practice in the Philippines

Fine-needle aspiration (FNA) is a well accepted initial approach in the management of thyroid lesions. It has come a long way since its introduction for nearly a century ago. In the Philippines, FNA of the thyroid was first introduced 30 years ago and has been utilized until now as a mainstay in the diagnosis of thyroid malignancy. The procedure is performed by pathologists, endocrinologists, surgeons, and radiologists. Most pathologists report the cytodiagnosis using a combination of the aspiration biopsy cytology method that closely resembles the histopathologic diagnosis of thyroid disorders and the six-tier nomenclature of The Bethesda System for Reporting Thyroid Cytopathology. Local endocrinologists and surgeons follow the guidelines of the 2015 American Thyroid Association in the management of thyroid disorders. There is still a paucity of local research studies but available data deal with cytohistologic correlations, sensitivity, specificity, and accuracy rates as well as usefulness of ultrasound-guided FNA. Cytohistologic correlations have a wide range of sensitivity from 30.7% to 73% and specificity from 83% to 100%. The low sensitivity can be attributed to poor tissue sampling since a majority of the thyroid FNA is done by palpation only. The reliability can be improved if FNA is guided by ultrasound as attested in both international and local studies. Overall, FNA of the thyroid has enabled the diagnosis of thyroid disorders with an accuracy of 72.8% to 87.2% and it correlates well with histopathology.

Current Status of Thyroid Fine-Needle Aspiration Practice in Thailand

Thyroid carcinoma is one of the leading malignancies in Thailand increasingly prevalent in the female population. Fine-needle aspiration (FNA) cytology is a widely used diagnostic tool for evaluation of thyroid nodules and thyroid cancer. Thyroid FNA is a routine procedure universally performed in Thai hospitals by a variety of clinical specialists. Manual guidance is the first-line choice complemented by ultrasound assistance in selected cases. Despite national guidelines recommendations, the diagnostic criteria and terminology of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was slowly adopted in the local settings. Currently, the Bethesda system is actively promoted by the local professional societies as a uniform reporting system. Experience with thyroid FNA has been rarely reported to date—only a handful of publications are available in local journals. Our review, in addition to presenting various aspects of thyroid FNA in Thailand, established for the first time national references for a certain statistical outputs of TBSRTC based on the original multi-institutional cohort. The risk of malignancy in 2,017 operated thyroid nodules collected from three tertiary thyroid cancer centers was 21.7%, 14.7%, 35.9%, 44.4%, 76.7%, and 92.6% for categories I to VI, respectively. The malignancy risk in several diagnostic categories (II to IV) was higher than the risk estimated by TBSRTC and recent meta-analysis studies. We endorse the use of uniform terminology of the Bethesda system in Thailand, which will help facilitate communication among diverse medical professionals involved in the management of patients with thyroid nodules, to share local experience with the international audience.

Citologías cervico-vaginales no satisfactorias en el hospital “Manuel Noriega Trigo” de Maracaibo / Unsatisfactory cervico-pap tests at the hospital

Objetivo: Determinar el porcentaje de citologías cervico-vaginales no satisfactorias en el Hospital “Manuel Noriega Trigo”. Métodos: Se revisaron retrospectivamente las citologías cervico-vaginales estudiadas en el Servicio de Anatomía-Patológica del período comprendido entre noviembre 2008 a diciembre de 2009. Resultados: Se revisaron 1 566 citologías cervico-vaginales reportándose 126 como insatisfactorias (8.%). Las causas más frecuente de citologías cervico-vaginales no satisfactoria fue la falta de identificación del paciente (n=53, 36,8 %), la abundancia de leucocitos (n=31, 21,5 %) y la presencia de abundantes hematíes (n=26, 18,1 %). Diez y siete citologías cervico-vaginales (14,3 %) presentaron varias causas para ser catalogadas como insatisfactorias. Ochenta (63,5 %) de 126 citologías cervico-vaginales reportadas insatisfactorias fueron reportadas como negativas para malignidad. Cuarenta (31,7 %) de las (126 citologías cervico-vaginales) insatisfactorias fueron consideradas como imposibles de ser analizadas o estudiadas por el citotecnólogo o patólogo, representaron el 2,6 % del total de las estudiadas. En 33 citologías cervico-vaginales (2,1 %), no se encontraron células endocervicales. Los centros asistenciales que presentaron un mayor número de citologías cervico-vaginales no satisfactorias fueron el Hospital “Manuel Noriega Trigo” con 63 (50 %), Ambulatorio El Silencio con 31 (24,6 %) y el Ambulatorio El Caujaro con 17 (13,5 %), sin embargo, en proporción, fueron los Ambulatorios El Silencio (31 de 133 citologías cervico-vaginales, 23,3 %) y El Caujaro (17 de 115 citologías cervico-vaginales, 14,8 %) los que tuvieron mayor número de citologías cervico-vaginales insatisfactorias. Conclusiones: El porcentaje de citologías cervico-vaginales insatisfactorias fue aceptable cuando se analizaron las causas propias de la toma, procesamiento y lecturas de las citologías cervico-vaginales. Asimismo, el porcentaje de ausencia de células ...

Objective: To determinate the percentage of unsatisfactory Pap smears at Manuel Noriega Trigo Hospital. Methods: Pap smears studied by the Service of Pathology were reviewed retrospectively between November 2008 and December 2009. Results: One hundred twenty six (8 %) of 1 566 Pap smears were reported unsatisfactory. The most common cause of unsatisfactory vaginal cytology was the lack of patient´s identification (n=53, 36.8 %), obscuring smear inflammation (n=31, 21.5 %) and blood (n=26, 18.1 %). Seventeen Pap smear (14.3 %) had several causes to be considered non satisfactory. Eighty (63.5 %) of 126 Pap smear unsatisfactory were negatives to malignancy. Forty (31.7 %) of 126 Pap smear unsatisfactory could not be analyzed neither the cytotechnogist nor the pathologist; they represented 2.6 % of the 1566 Pap smear. Thirty three Pap smear (2.1 %) did not have endocervical cells. Hospital “Manuel Noriega Trigo” (n=63.50 %), El Silencio (n=31, 24.6 %) and El Caujaro (n=17, 13.5 %) have higher number of unsatisfactory vaginal cytologies, however, proportionally El Silencio (31 of 133 Pap smear, 23.3 %) and El Caujaro (17 of 115 Pap smear, 14.8 %) had higher unsatisfactory Pap smears. Conclusion: The percentage of unsatisfactory Pap smears was acceptable when we analyzed causes such as the technique of collection of the Pap smear, the staining technique, and the study of the slide. The number of endocervical cells was low even though the endocervical collection sample was taken with a cotton swab, maybe because Pap smear were taken by medical doctors.

Review of atypical cytology of thyroid nodule according to the Bethesda system and its beneficial effect in the surgical treatment of papillary carcinoma / 대한외과학회지

PURPOSE: For the atypical cases of fine needle aspiration (FNA) cytology of thyroid nodules, ultrasonographic findings are a primary guideline for the surgical treatment. However, they have the intrinsic risk of overtreatment, as well. In this study we examined whether the Bethesda system could provide a real effect on the diagnostic rate of atypical cytology, and thereby reduce the number of cases diagnosed as atypical from FNA cytology. METHODS: We reviewed 166 cases diagnosed as atypical by FNA cytology at this institute between the years 2005 to 2010. We classified these cases on the basis of ultrasonographic and cytological findings and compared them with the histological results. RESULTS: Ultrasonographically, findings suspicious for malignancy and indeterminate were associated with 83.7% and 47.2% of malignancy rates, respectively. Cytopathologically, the malignancy rates varied according to the main cytological features and the highest malignancy rate was 77.3%. Based on the Bethesda system, 39.2% of the cases diagnosed as atypical could be grouped into the category of suspicious for malignancy and yielded a malignancy rate of 76.9%. CONCLUSION: Although ultrasonography provides an excellent guideline for the surgical treatment of atypical cases, it also showed considerable risk of overtreatment. The Bethesda system did not offer definitive effects on the rate of atypical cytology, but this system seemed to provide stricter boundaries for the atypical cytology and to aid in reducing the rates thereof. This in turn may permit that more limited cases are allotted to ultrasonographic decision making.

Comparison between two cervical/vaginal cytologic methods for diagnosing the early cervical diseases / 重庆医科大学学报

Objective:To compare the positive rate and its coincidence with biopsy of HE staining-Pap's classification and Pap's staining-The Bethesda System(TBS).Methods:HE staining-Pap's classification were used to examine 4005 smears from January to June in 2001, while 2947 smears from April to August in 2002 were screened by Pap's staining-TBS. Meanwhile the abnormal cases were finally diagnosed by histopathology.Results:The positive rate of Pap's staining-TBS (5.29%) were significantly higher than that of traditional Pap's classification(0.32%)( P

Qualification of Atypical Squamous Cells of Undetermined Significance - "ASCUS, R/O HSIL": Cytologic Features and Histologic Correlation / 대한세포병리학회지

Cytologic and histopathologic features and human papillomavirus (HPV) DNA detection associated with 101 cervicovaginal smears which are classified as 'atypical squamous cells of undetermined significance, rule out high grade squamous intraepithelial lesion(ASCUS, R/O HSIL)' were reviewed and compared to 89 smears of 'ASCUS, not otherwise specified(NOS)' . Cytologic fieatures of ASCUS, R/O HSIL included atypical single small cells(36.6%), hyperchromatic tissue fragments(35.6%), atypical metaplastic cells(18.8%), endometrial cell-like clusters(5.9%), and atypical parakeratotic cells(3.0%). A final diagnosis of HSIL on biopsy was assigned to 47(54.0%) of 87 women with ASCUS, R/O HSIL and to 13(14.6%) of 89 women with ASCUS, NOS ( p=0.000). There was no difference in HPV DNA detection rate between ASCUS, R/O HSIL and ASCUS, NOS smears. These data suggest that subclassification of ASCUS is helpful to manage patients because ASCUS, R/O HSIL is more often associated with an underlying HSIL on biopsy. Therefore, women with ASCUS, rule out HSIL should be actively managed with colposcopic examination.

The Bethedsa System 2001 Workshop Report / 대한세포병리학회지

The Bethesda System (TBS) was first developed in 1988 for the need to enhance the communication of the cytopathologic findings to the referring physician in unambiguous diagnostic terms. The terminology used in this reporting system should reflect current understanding of the pathogenesis of cervical/vaginal disease, so the framework of the reporting system should be flexible enough to accommodate advances in medicine, including virology, molecular biology, and pathology. Three years after the introduction of TBS, the second Bethesda workshop was held to set or amend diagnostic criteria for each categories of TBS. TBS 1991 is now widely used. The third Bethesda workshop, The Bethesda System 2001 Workshop, was held in National Cancer Institute, Bethesda, Maryland from April 30 to May 2, 2001. Again, the goals of this workshop were to promote effective communication and to clarify in reporting cervical cytopathology results to clinicians and to provide with the information to make appropriate decisions about diagnosis and treatment. Nine forum groups were made and there were Web-based bulletin board discussions between October, 2000 and the first week of April, 2001. On the basis of bulletin board comments and discussions, the forum moderators recommended revised terminologies in the Workshop. Hot discussions were followed after the presentation by forum moderators during the workshop. Terminologies confusing clinicians and providing no additional informations regarding patient management were deleted in the workshop to clarify the cervicovaginal cytology results. Any informations related to the patient management were encouraged to add. So 'Satisfactory for evaluation but limited by' of 'Specimen Adequacy' catergory was deleted. Terminology of 'Unsatisfactory' was further specified as 'Specimen rejected' and 'Specimen processed and examined, but unsatisfactory'. Terminologies of 'Benign Cellular Change' and 'Within Normal Limits' were combined and terminology was changed to 'Negative for intraepithelial lesion

Histologic Diagnosis of Cervcial Precursor Lesion: Applying the Bethesda System and HPV 16, 18 Correlates / 대한산부인과학회잡지

OBJECT: To support the application of the Bethesda classification to the histologic diagnosis of cervical squamous lesions. METHODS: We evaluated the cervical biopsies and human papilloma virus (HPV) DNA status of 100 clinic patients. The 100 biopsy specimens were analyzed using criteria of the Bethesda system for low-grade squamous intraepithelial lesion(LSIL) and high-grade squamous intraepithelial lesions(HSIL) in association with analysis of HPV DNA virus type by PCR. RESULTS: By PCR amplified from paraffin embedded tissues, the 40 of 90 cases of classified as HSIL were HPV 16 or 18 positive and 1/10 cases of classified as LSIL was HPV 16 positive. CONCLUSION: This study supports the usefullness of certain histologic criteria of the Bethesda system for distinguishing squamous intraepithelial lesions into two grades.

The Outcomes of 17,744 Cervicovaginal Smears in Ihha University Hospital / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to investigate the distribution of the result of 17,744 cervicovaginal smears and their pathologic results in Inha University Hospital to make a reference data. METHODS: During 28 months, May 1996 to August 1998, we performed 17,774 cervicovaginal smears and arranged them by the Bethesda system and compared them with their pathologic results. RESULTS: Among 17,744 smears, there were 93.2% of benign results, 2.9% of ASCUS, 0.9% of LSIL, 1.4% of HSIL, and 0.8% of SCC. The ASCUS/SIL ratio was 1.28. Among ASCUS, the high grade histologic outcome was composed 4.0%. Among LSIL, there were 15.7%, and HSIL 48.0%, SCC 56.1%, AGUS 9.3%, and Adenocarcinoma, the results was 69.2%. CONCLUSION: Among 17,744 smears, there were 93.2% of benign results, 2.9% of ASCUS, 0.9% of LSIL, 1.4% of HSIL, and 0.8% of SCC. The ASCUS/SIL ratio was 1.28. These results were very similar to other data and we would like to add our data to them as a reference. And the worse the smear results were, the worse the pathologic results were.

ASCUS, AGUS and Benign Endometrial Cells in Cervicovaginal Smears: Histologic Correlations and Clinical Significance / 대한부인종양콜포스코피학회잡지

OBJECTIVE: The purpose of this study is to evaluate the histologic correlations and the clinical significance among patients with atypical squamous cells of undetermined significance (ASCUS), atypical glandular cells of undetermined significance(AGUS) and benign endometrial cells identified on cervical Pap smear screening. MATERIALS & METHODS: The computerized files of the Department of Pathology at Samsung Cheil Hospital were searched from 1991 to 1997 to evaluate the annual statistics of cytologic diagnoses including normal/benign, ASCUS, AGUS, low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion(HSIL) and cancer classified by the Bethesda System(TBS). Cytohistologic correlations on follow-up were separately analysed in ASCUS(190 cases), AGUS(268 cases) and benign endometrial cells(169 cases), respectively. Additionally, post-menopausal squamous atypia(83 cases) were also included in this study. TBS terminology was used in both cytologic and histologic diagnoses. RESULTS: During 7-year period (1991-1997), 447,049 cervicovaginal smears were evaluated. The median rate of abnormal cytology was 4.4%, with 2.1% of ASCUS, 2.06% of squamous intraepithelial lesion(SIL), and 0.08% of AGUS. The median ratio of ASCUS versus SIL was 1.24. Specimen adequacy was evaluated on 47,525 cases, of which categories of "satisfactory for evaluation but limited by" and "unsatisfactory for evaluation" were 28.3% and 0.03%, res-pectively. Follow-up of 190 patients with ASCUS cytology showed 30%(57 cases) with SIL on biopsy; 18%(35cases) with LSIL, 11%(21cases) with HSIL, and 1%(1case) with microinvasive squamous cell carcinoma. On histologic examination, 77%(37/48cases) with ASCUS favoring SIL revealed SIL in contrast to 14%(20/142cases) with ASCUS favoring reactive change, which is statistically significant.(Chi-Square test, P<0.0001). Of 83 cases of post-menopausal squamous atypia(PSA), smears with LSIL showed 34.9%(15/43cases) with LSIL on biopsy. 268 patients with AGUS smears had 25%(67cases) with clinically significant cervical or endometrial lesions on histologic examinations. Among 17.9%(48cases) with cervical lesions, squamous abnormalities were 10.5%(28cases); including 1.5%(4cases) with LSIL and 9.0%(24cases) with HSIL. Glandular lesions in cervix were 7.5%(20cases); 3.0%(8cases) of glandular atypia or dysplasia, 1.9%(5cases of adenocarcinoma in situ, 1.1%(3cases) of microinvasive adenocarcinoma and 1.5%(4cases) of adenocarcinoma. Of 7.1%(19cases) of endometrial lesions, 2.2%(6cases) was endometrial hy-perplasia, 4.1%(11cases) endometrial carcinoma, 0.4%(1case) MMMT and 0.4%(1case) metastatic adenocarcinoma from stomach were verified. The pathologies of 169 cases with benign endometrial cells shed in cervicovaginal smears were confirmed to be endometrial polyp(8.3%), endometrial hyperplasia(4.1%) and endometrial carcinoma(5.9%). CONCLUSION: The results of this study indicates that clinicians should communicate with pathologists for proper management of abnormal cytology. Further evaluation and decision of management should be made based on input from pathologists as well as on clinical setting and professional guidelines.

Histologic and Cytologic Follow-up in Atypical Squamous Cells of Undetermined Significance(ASCUS) on Cervical Smears / 대한세포병리학회지

In 1988, The Bethesda System for reporting cervical and vaginal cytologic diagnoses was introduced and this was revised in 1991. The new diagnostic category "atypical squamous cells of undetermined significance(ASCUS)" introduced by The Bethesda System is an area of controversy about the diagnostic category, clinical significance and appropriate treatment. A retrospective 2 years and 9 months study(April,1994-December,1996) was performed to evaluate the significance of reporting ASCUS on cervical smears. Sixtyseven(1.17%) of 5,730 smears were diagnosed as ASCUS and 21 cases were followed by cervical biopsies and/or endocervical curettages in 4 cases(19%), and repeat cervical smears in 17 cases (81%). Tissue diagnoses were benign in 2 cases and squamous cell carcinoma in situ in 2 cases. Cytologic diagnosis of follow up smear were negative in 14 cases (82.4%) and persistent ASCUS in 3 cases(17.6%).

The Bethesda System(TBS): A New Reporting System of Cervicovaginal Smear / 대한세포병리학회지

In 1989, the Bethesda System(TBS) was introduced as an attempt to standardize cervical/vaginal reporting systems. TBS nomenclature was created for reporting cytologic diagnoses to replace the currently used Cervical Intraepithelial Neoplasia(CIN) and Papanicolaou Class System which are deemed less reproducible. The name for preinvasive squamous lesions was changed to squamous intraepithelial lesion(SIL), subdivided into low-grade and high-grade type. TBS recommends a specific format for cytologic report, starting with explicit statement on the adequacy of the specimen, followed by general categorization and descriptive diagnosis. Pathologic and epidemiologic studies performed over last 10 years have provided evidence that human, papillomavirus(HPV) plays a significant role in the development of cervical neoplasia. TBS corresponds not only to currently held views of the behavior of preinvasive lesions and their HPV distribution, but also to the current guidelines for clinical management.