title: Evaluation of the atypical cytologic smear. Validity of the 1991 Bethesda System.
abstract: The 1991 Bethesda System states that atypical squamous or glandular cells of undetermined significance should be further classified as reactive or premalignant/malignant. The validity of this qualification for identification of patients with cervical intraepithelial neoplasia (CIN) was tested. One hundred twenty-four cytologic smears with squamous atypia were reviewed retrospectively by two cytopathologists blind to the colposcopy results. The smears were classified as favoring either reactive or premalignant/malignant processes. Subjective criteria used in the classification were based on the pathologists' experience. All patients underwent colposcopy and selected biopsy under the direction of a gynecologic oncologist. Of the 124 atypical smears, 69 were classified as favoring reactive processes and 55 as favoring premalignant/malignant processes by cytopathologist 1. Cytopathologist 2 classified 68 as reactive and 56 as premalignant/malignant. Colposcopy and selected biopsy revealed the following lesions: 34 cases of human papillomavirus (27.4%), 17 of CIN 1 (13.7%), 4 of CIN 2 (3.2%), 2 of CIN 3 (1.6%) and 67 without pathology (54.0%). All six patients with squamous atypia and underlying CIN 2 and 3 lesions had their cytology classified as premalignant/malignant by the cytopathologists. In these patients this qualification had high sensitivity (100%) and negative predictive value (100%). The 1991 Bethesda System classification above, when applied to patients with squamous atypia, was effective in identifying patients with serious pathologic cervical lesions. If used as a triage method, colposcopy should be reserved for atypical lesions classified as premalignant/malignant, potentially decreasing the cost of health care without decreasing the quality of that care.
authors: Department of Obstetrics and Gynecology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors: E A
authors: EA
authors: Widra
authors: D
authors: D
authors: Dookhan
authors: A
authors: A
authors: Jordan
authors: P
authors: P
authors: McCue
authors: M
authors: M
authors: Bibbo
authors: C J
authors: CJ
authors: Dunton
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003127:Colposcopy; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000145:classification* / Q000453:epidemiology / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014412:Tumor Virus Infections / Q000145:classification* / Q000453:epidemiology / Q000473:pathology*; D002577:Uterine Cervical Diseases / Q000145:classification* / Q000453:epidemiology / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000145:classification* / Q000453:epidemiology / Q000473:pathology*; D014626:Vaginal Smears / Q000379:methods / Q000592:standards*; D002578:Uterine Cervical Dysplasia / Q000145:classification* / Q000453:epidemiology / Q000473:pathology*