title: Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda System.
abstract: The newly introduced Bethesda System proposes to replace the terms dysplasia, carcinoma in situ (CIS), or cervical intraepithelial neoplasia (CIN) with two terms, low-grade squamous intraepithelial lesion (SIL) or high-grade SIL. We tested the biologic relevance of the Bethesda System (ie, its ability to establish a close correlation between biologic behavior and the different grades of lesions) in a series of 528 women with genital human papillomavirus (HPV)-associated precancerous lesions prospectively followed for 10 years. The cervical biopsies were reclassified as either low-grade or high-grade SIL, and the data obtained by colposcopy, Papanicolaou smear, and HPV typing, as well as the biological behavior of the lesions, were analyzed in these two groups. Altogether, 77.4% (376 of 486) of the lesions were classified as low-grade SIL lesions; the rest (22.6%) belonged to the high-grade SIL category. In the low-grade SIL category, 46.8% of the women were 24 years old or younger, as compared with 37.3% in the high-grade SIL group. The colposcopic appearance was normal significantly more frequently in the low-grade SIL lesions (22.1%) than in the high-grade category (8.5%) (P less than .001). A single Papanicolaou smear was inadequate to distinguish between low-grade and high-grade SIL, as evidenced by almost identical distributions of Papanicolaou smear class I and II cells in both categories. Noteworthy was the discovery of normal Papanicolaou smears in 8.2% of the high-grade SIL lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Pathology, Kuopio Cancer Research Centre, University of Kuopio, Finland.
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
authors.forename: V
authors.initials: V
authors.lastname: Kataja
authors.forename: M
authors.initials: M
authors.lastname: Yliskoski
authors.forename: F
authors.initials: F
authors.lastname: Chang
authors.forename: S
authors.initials: S
authors.lastname: Syrjänen
authors.forename: S
authors.initials: S
authors.lastname: Saarikoski
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003127:Colposcopy; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics; D011446:Prospective Studies; D009626:Terminology as Topic; D014412:Tumor Virus Infections / Q000145:classification* / Q000382:microbiology / Q000473:pathology; D002578:Uterine Cervical Dysplasia / Q000145:classification / Q000382:microbiology / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000145:classification* / Q000382:microbiology / Q000473:pathology; D014626:Vaginal Smears
chemical_list: D004279:DNA, Viral