THE BETHESDA SYSTEM AND EVALUATION OF ABNORMAL PAP SMEARS IN HIGH GRADE SQUAMOUS INTRAEPHITELIAL LESION

WAN IDA YAZMIN , NUR IZZA NAIM, NUR FARAH AIDA, NOR NASUHA, SHAZANA, NORSYAZWANI, NUR FAZILAH,
Department of Medical Laboratory Technology, Faculty of Health Science, UiTM, Puncak Alam Campus.
 
INTRODUCTION DIFFERENTIATION BETWEEN HSIL AND ASC-H
 
Coarse Chromatin
The Bethesda System (TBS) Dense cytoplasm Irregular nuclear contour
System reporting cervical cytological diagnose in Pap Smear which   Hyperchromasia
describe precancerous changes in cervical cells for squamous
intraepithelial lesion (SIL) (Apgar et Al. 2003).
 
Scanty cytoplasm Thick nuclear membrane
BETHESDA SYSTEM 1991 BETHESDA SYSTEM 2001
Figure 1: High-Grade Squamous Intraepithelial Lesion (HSIL) (CP) High
Magnification (100x)
HSIL encompasses SIL consist of ASC-US, Severe dysplastic cells with some variation in cell size and high N/C ratio.
moderate and severe LSIL, ASC-H and HSIL. Central, enlarged nuclei Metaplastic cell with
Hyperchromasia , coarse chromatin, scanty cytoplasm and thick nuclear
dysplasia, carcinoma in with coarse chromatin enlarged nuclei
membrane.
situ and CIN 2, 3. (American Society of Cytopathology)
Figure 4: HSIL. Evenly Figure 5: ASC-H. Metaplastic cells
distributed coarse chromatin, with enlarged nuclei, nuclear
ATYPICAL SQUAMOUS CELL- “CANNOT EXCLUDE” HSIL
Table 1: Comparison between Bethesda System 1991 and centrally placed enlarged nuclei, contour irregularities variation in
(ASC-H) and dense cytoplasmic. (CP) size, shape, and ratio of nuclear to
Bethesda System 2001
(American Family Physician Journal, 2003) High Magnification (100x) cytoplasmic area. (CP) Medium
MORPHOLOGY ASC-H Magnification
HSIL: Condition characterized by a number of immature cells, General Number of Fewer atypical cells (American Society of Cytopathology)
precancerous and if not removed may progress to invasive cells
cancer (http://www.bd.comp, 2010). Appearance Singly cell or discohesive
ALGORITHM
ASC-H: Atypical squamous cells that exhibit few similar features Nucleus Size 1-2 times larger than normal
suggestive of but not sufficient to report HSIL (Chivukula M Chromasia Hyperchromasia
& Shidham VB, 2006) Chromatin Coarse and unevenly
dispersed chromatin
Membrane Prominent nuclear
HIGH SQUAMOUS INTRAEPITHELIAL LESION (HSIL) membrane irregularities
Nucleoli Lack of nucleoli
MORPHOLOGY HSIL
Cytoplasm Staining Cyanophilic
General Cell size Small parabasal cell sizes Appearance Scanty cytoplasm
Aggregate In sheets or in syncytial- Less dense
like aggregates N/C ratio High
Nucleus Size Variation in nuclear size Diathesis Absent
Moderate enlarge
Shape Round to oval Table 3: Characteristics of ASC-H
(Chivukula M & Shidham VB, 2006)
Chromasia Hyperchromasia
SUMMARY
Chromatin Fine or coarsely granular
and evenly distributed High N/C ratio Cytologic changes of ASC-H is likely suggestive of HSIL but
Membrane Thick nuclear membrane exhibit features that are not sufficient to report as HSIL.
Nucleoli Absent Irregular nuclear contour
Early detection of HSIL can prevent cervical cancer.
Cytoplasm Staining Cyanophilic
REFERENCES
Appearanc Scanty cytoplasm
Coarse chromatin
e Lacy and delicate •American Society of Cytopathology. (n.d.). Retrieved October 12, 2010, from NCI Bethesda System:
http://nih.techriver.net/atlas.php
Densely metaplastic •Apgar, B. S., Zoschnick, L., & Wright, T. C. (2003). The 2001 Bethesda System terminology.
American family physician , 1992-1998.
N/C ratio Markedly high •Chivukula, M., & Shidham, V. B. (2006). ASC-H in Pap test--definitive categorization of
Figure 2: ASC-H. Singly cell show Figure 3: ASC-H. High N/C ratios
Diathesis Absent nuclei have coarse chromatin
cytomorphological spectrum. CytoJournal , 14.
and nuclear contour irregularities. •Solomon, D., & Nayar, R. (2004). The Bethesda System for Reporting Cervical Cytology (2 ed.). New

Table 2: Characteristics of HSIL without nucleoli. High N/C ratios. (LBP) High Magnification (100x)
York: Springer.
•Vassilakos, P., Petignat, P., Boulvain, M., & Campana, A. (2002). Primary screening for cervical
(Solomon & Nayar, 2004) (LBP) High Magnification (100x) cancer precursors by the combined use of liquid-based cytology, computer-assisted cytology and HPV
(Chivukula M & Shidham VB, 2006)  DNA testing. British Journal of Cancer , 382-388.