title: The Bethesda System. Impact on reporting cervicovaginal specimens and reproducibility of criteria for assessing endocervical sampling.
abstract: This study examined the impact of applying the Bethesda System guidelines for specimen adequacy on cytopathologic diagnosis at the Johns Hopkins Hospital laboratory of cytopathology during a one-year period. Application of the Bethesda guidelines resulted in a 1.3% unsatisfactory rate. In addition, 3.8% of specimens were satisfactory but contained an inadequate endocervical component (IEC). Smears obtained after a cone biopsy or an initial IEC smear were IEC in 16.5% and 18.7% of cases, respectively. The IEC rate following an initial smear lacking an endocervical component was 11.8% in repeat specimens obtained with an endocervical brush as compared to 29.4% in those obtained with a spatula alone. The reproducibility of the Bethesda criteria for assessing endocervical sampling was evaluated by comparing the level of agreement between three independent reviewers examining 40 test cases. Three-way agreement was achieved in 75% of cases. Two-way agreement ranged from 80.0% to 87.5%. We conclude that implementation of the Bethesda System guidelines for assessing specimen adequacy should produce a minimal impact on cytopathologic reporting and gynecologic practice. Repeat specimens lacking an endocervical component may be encountered relatively frequently in certain subsets of patients.
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: M E
authors.initials: ME
authors.lastname: Sherman
authors.forename: M
authors.initials: M
authors.lastname: Weinstein
authors.forename: M
authors.initials: M
authors.lastname: Sughayer
authors.forename: J O
authors.initials: JO
authors.lastname: Cappellari
authors.forename: J E
authors.initials: JE
authors.lastname: Orr
authors.forename: Y S
authors.initials: YS
authors.lastname: Erozan
authors.forename: M H
authors.initials: MH
authors.lastname: Schiffman
authors.forename: R J
authors.initials: RJ
authors.lastname: Kurman
mesh_terms: D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014626:Vaginal Smears