Applications of the yignalin system for cervical cytological reporting

ABSTRACT

The Bethesda System [TBS] for reporting the results of cervical cytology was developed as a uniform system of terminology that would provide clear guidance for clinical management. According to TBS, the diagnostic report should include a recommendation for further evaluation when appropriate. The aim of this wok was to use TBS terminology in classification of abnormal cervical Pap smears or with persistent significant inflammatory changes, and correlate the results with the final histopathological findings for optimum evaluation and clinical use. This prospective study was conducted in the Cytocolposcopic Unit of Teaching Laboratories and Outpatient Department of Medical City Teaching Hospital over a period of one year [Sep. 2001- Sep. 2002]. Eighty-three married females were included in the study. A cervical smear was taken followed by a punch biopsy, taken under colposcopic guidness, from the suspicious lesions for histopathological study. All cytological interpretations were reported and categorized according to The Bethesda System [TBS]. The rate of different cytological and histopathological findings and a comparison between the results were estimated by a special statistical analysis. Minimal cytological abnormalities were significantly more common than high-grade squamous intraepithelial lesion/HGSIL [95.5% compared to 4.5% respectively]. Atypical squamous cells of undetermined significance/ASCUS, as a single entity, was the most common cytological abnormality [44.8%], followed by low-grade squamous intraepithelial lesion/LGSIL [41.8%], atypical glandular cells of undetermined significance/AGUS [9%], and then HGSIL [4.5%]. [24.1%] of ASCUS in cytology was associated with underlying CIN [SIL] lesions in histopathology, out of those, [20.7%] had CIN1/LGSIL and [3.4%] had CINII-III/HGSIL [14.3%] of cases with LGSIL.in cytology had CIN II-III [HGSIL] in histopathology, while HGSILs in cytology were associated with 100% high-grade lesions in histopathology. The most common cytologic diagnoses immediately preceding the discovery of histologic HGSIL were LGSIL [57.1%], ASCUS [14.3%], and then HGSIL [28.6%]. Minimal cytological abnormalities in cervical smears were significantly more common than HGSIL. ASCUS, as a single entity, was the most common cytological abnormality. All cases of HGSIL, in cytology, were found to have the same diagnosis by histopathology. So all cases with HGSIL in cytology should be immediately referred for colposcopy for final diagnosis. On the other hand, cases with minor cytological abnormalities were found to have high-grade lesions in histopathology in only 3.3% of women referred with ASCUS smears, and 14.3% of those with LGSIL smears. The latter finding demonstrates that an adjunctive method like colposcopy or close follow-up [particularly with three-smear follow up] is recommended to rule out high-grade lesions