THE BETHESDA SYSTEM AND EVALUATION OF LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION

OPTIONAL (LSIL)
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SITI FATIMAH G., MUHAMMAD ZAKI R., DOMINIC B., SYAWAL SHAFIE A.R., MOHD LUKMAN M.Y., MOHAMAD SHAHRUL NIZAM M.R.
BACHELOR OF MEDICAL LAB TECHNOLOGY(HONS), FACULTY OF HEALTH SCIENCE, UNIVERSITI TEKNOLOGI MARA PUNCAK ALAM CAMPUS, 42300
BANDAR PUNCAK ALAM SELANGOR

INTRODUCTION Cytomorphology of LSIL / Mild Dysplasia / CIN 1 Cytological view: 3) Women with HPV infection is a precursor lesions for the cervix to
persist longer and progress more quickly to cancerous lesion than
THE BETHESDA SYSTEM women with non HPV infection.
The Bethesda System was firstly introduced in 1988 and revised in (Schlecht, N.F, 2003)
1991. The Bethesda System 2001 is an incremental change in the
Bethesda System 1991 for reporting cervical or vaginal cytologic Management of Initial Abnormal Pap Smear (LSIL Algorithm)
diagnoses. The Bethesda System 2001, includes specimen
adequacy, general categorization and interpretation and result.
(Crothers B.A.,2005)
BETHESDA FORM 1991 BETHESDA FORM 1991

(Solomon D, Nayar R, 2004)

LSIL: comparison between Bethesda 1991 and 2001 (Cibas E.S, Ducatman B.S, 2003)

THE BETHESDA 2001 THE BETHESDA 1991 Pitfalls:

Ephitelial cell abnormalities- Ephitelial cell abnormalities-
Squamous cell Squamous cell Summary
Atypical squamous cell Atypical squamous cell of
-Of undetermined significance undetermined significant (Qualify) 1) The Bethesda System 2001 is a modification of Bethesda 1991
(ASCUS) Low grade squamous intraepithelial were based on extensive review of the Cervical Cancer
-Cannot exclude HSIL lesion Screening, including new methodology and technology.
(ASC-H) -Encompassing: Human 2) LSIL in The Bethesda System 2001 describe a range of
Low grade squamous intraepithelial papillomavirus (HPV)/mild noninvasive squamous epithelial abnormalities, these include
lesion (LSIL) (encompassing: HPV/ mild dysplasia / CIN1 ) cytophatic effect by HPV and mild dysplasia (CIN 1)
dysplasia / CIN I) 3) LSIL can be missed diagnosed with ASCUS by few similar
criteria
(Crothers B.A., 2005) 4) Management of patient with LSIL:
- repeat smear 3 to 6 month.
Dysplasia - Terms used to describe abnormal changes in the cell Report - if the women have infected with HPV is recommended to done
found on the cervix layer. Dysplasia stages are mild, moderate and colposcopy with directed biopsies.
severe according to the effect on the cervix layer. a) Satisfactory for evaluation: Endocervical cell or transformation References
(Mckinley,2009) zone cell seen or not seen.
Low Grade Intraepithelial Lesion (LSIL) refers to early changes in the Histological view: b) Interpretation: Low Grade Squamous Intraepithelial Lesion (LSIL) 1) Salomon D, Nayar R (2004), The Bethesda System for Reporting Cervical
size, shape and number of cells on the 1/3 of the cervix layer. LSIL / LSIL with HPV changes. Cytology, 2nd .Ed.New York, Springer-Verlag.
also referred as: c) Suggestion: Repeat smear after 6 month. 2) Cibas E.S.,Ducation B.S. (2003), Cytology Diagnostic Principles and Clinical
Correlates.
• mild dysplasia (Solomon D, Nayar R, 2004) 3) Crothes A. B. , (2005) The Bethesda System 2001: Update on Terminology and
• mild dysplasia with HPV Application. Retrieved from www.labec.net/doc/bethesda ,on 30 September 2010
• cervical intraepithelial noeplasia (CIN 1) 4) Mckinley (2009), Cervical Dysplasia, Retrieved from
General features:
Management http://www.mckinley.uiuc.edu, on 29 September 2010.
1) Polyglonal shaped cells occur singly or in sheets. 5) Schlecht , N.F. et al (2003), HPV Infection and Time to Progression and
1) Mild dysplasia are prone revert to normal than to progress to cancer Regression of Cervical Intraepithelial Neoplasia. Retrieved from
2) Abundant cytoplasm stains either basophilic or eosinophilic according to a study. (National Cancer Institute 1999). http://www.jnci.oxfordjournals.org on 28 September 2010.
3) Occasionally, there is a distinct cleared area surrounding the 2) Mild dysplasia (LSIL) should have a repeat smear 6 month rather than 6) http://www.cytologystuff.com/indexwork.htm. Retrieved on 23 September 2010.
nucleus (koilocytosis). colposcopy and biopsy procedure. (Josefson D, 1999) 7) http://www.asccp.com Retrieved on 24 September 2010.
(Solomon D., Nayar R., 2004) 8) http://nih.techriver.net Retrieved on 24 September 2010.
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