The Bethesda System for reporting the results of cervical cytology developed as a uniform system of cytology reporting that would provide clear guidance for clinical management (45). It creates a standardized framework for laboratory reports that includes a descriptive diagnosis and an evaluation of specimen adequacy. The Bethesda System was modified to reﬂect the development of new technologies and research findings.
In the Bethesda System, specimen adequacy is categorized as satisfactory or unsatisfactory for evaluation. If a specimen is found to be unsatisfactory, cervical cytology is repeated promptly. Otherwise the specimen is classified as satisfactory. If sampling of the transformation zone is inadequate or obscuring factors are present, cervical cytology can be repeated in 6 to 12 months. The general categorizations are (i) negative for intraepithelial lesion or malignancy, (ii) epithelial cell abnormality, and (iii) other. In the category of negative for intraepithelial lesions or malignancy, evidence for the presence of trichomonas vaginalis, candida, bacterial vaginosis, actinomyces, and herpes simplex virus may be noted. Included in this category are reactive cellular changes, glandular cells status after hysterectomy, and atrophy. The category epithelial cell abnormality includes squamous cell and glandular cell abnormalities. The rest of the categories of ASC, LSIL and HSIL remain unchanged from the classification noted above (Table 19.2).
The group of glandular cell abnormalities includes atypical glandular cells (AGC), which are further described by the terms endocervical, endometrial, or glandular cells not
Table 19.2 Bethesda System 2001
Specimen Type: Indicate conventional smear (Pap smear) vs. liquid based vs. other
Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and any other quality indicators, e.g., partially obscuring blood, inﬂammation, etc.)  Unsatisfactory for evaluation. . . (specify reason)
Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify
Negative for intraepithelial lesion or malignancy Epithelial cell abnormality: See Interpretation/Result (specify “squamous” or “glandular” as appropriate) Other: See Interpretation/Result (e.g., endometrial cells in a woman 40 years of age)
If case examined by automated device, specify device and result.
Provide a brief description of the test methods and report the result so that it is easily understood by the clinician.
Negative for Intraepithelial Lesion or Malignancy (when there is no cellular evidence of neoplasia, state this in the General Categorization above and/or in the Interpretation/Result section of the report, whether or not there are organisms or other nonneoplastic findings)
Trichomonas vaginalis  Fungal organisms morphologically consistent with Candida spp. Shift in ﬂora suggestive of bacterial vaginosis  Bacteria morphologically consistent with Actinomyces spp. Cellular changes consistent with herpes simplex virus
Other Nonneoplastic Findings (optional to report; list not inclusive):
Reactive cellular changes associated with: inﬂammation (includes typical repair)  radiation  intrauterine contraceptive device (IUD)
Endometrial cells (in a woman 40 years of age) (specify if “negative for squamous intraepithelial lesion”)
Atypical squamous cells of undetermined significance (ASC-US)  cannot exclude HSIL (ASC-H)
Low-grade squamous intraepithelial lesion (LSIL) encompassing: HPV/mild dysplasia/CIN 1
High-grade squamous intraepithelial lesion (HSIL) encompassing: moderate and severe dysplasia, CIS/CIN 2 and CIN 3  with features suspicious for invasion (if invasion is suspected)