A cervicalis kenetek leletezésének terminológiája és kategóriái

Történeti áttekintés

Széleskörben ismert, hogy a kritériumok és a cervicalis kenetek leletezésében használt terminológia országonként különbözõ. Ez kommunikációs problémákat vetett fel a citopatológusok, elõszurõk és klinikusok között, nehézséget okozott az epidemiológusoknak a különbözõ méhnyakrák szurõprogramok hatásosságának összevetésekor. A terminológia változatossága meggátolja az érthetõ párbeszédet a laboratóriumok közt és kihatással van a betegellátásra, valamint az optimális módszerek bevezetésére.
A problémát 1988-ban rendezték az Amerikai Egyesült államokban, a National Cancer Institute által kidolgozott cervicalis citológiai leletezési rendszer, ismertebb nevén a Bethesda Rendszer (TBS) kidolgozásával. 1990-ben a Leonardo da Vinci program finanszírozta az Egyesített Terminológia Jegyzék kidolgozását, mely egyesítette cervicalis kenetek leletezésének rendszereit az Európai Únióban a Bethesda rendszerrel.
Az Eurocitológia weboldal kidolgozásába bevont partnerek a Bethesda rendszert ajánlották általános használatra. Az Egyesített Terminologiával kapcsolódó pontokat megtartották.

The main categories of the Bethesda reporting system (2001) are shown below:

SPECIMEN TYPE
2001 Bethesda System	Equivalent Terminology
Indicate whether conventional smear, endocervical brush specimen or liquid based cytology (LBC) specimen	Indicate whether conventional smear, endocervical brush specimen or liquid based cytology (LBC) specimen

SPECIMEN ADEQUACY
2001 Bethesda System	Equivalent Terminology
Satisfactory for evaluation (describe presence or absence of endocervical/transformation zone component and other quality indicators e.g. partially obscuring blood etc)	Satisfactory for evaluation Satisfactory for evaluation but limited by (specify reason)
Specimen rejected/not processed (specify reason)	Unsatisfactory for evaluation (specify reason)
Specimen process and examined but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)

GENERAL CATEGORISATION (optional)
2001 Bethesda System	Equivalent Terminology
Negative for intraepithelial lesion
Other: see Interpretation/Results
Epithelial Cell Abnormality (specify Squamous or Glandular as appropriate)

INTERPRETATION / RESULTS
2001 Bethesda System	Equivalent Terminology
Negative for intraepithelial lesion or malignancy	Negative
	Within normal limits
	Benign cellular changes

ORGANISMS DETECTED
2001 Bethesda System	Equivalent Terminology
Trichomonas vaginalis	Trichomonas vaginalis
Fungal organisms morphologically consistent with Candida spp	Candida spp
Shift in flora suggestive of bacterial vaginosis	Coccobacilli
Bacteria morphologically consistent with Actinomyces spp	Actinomyces spp
Cellular changes consistent with herpes simplex virus infection	Cellular changes indicate Herpes simplex virus infection

OTHER NON NEOPLASTIC FINDINGS (optional; list not inclusive)
2001 Bethesda System	Equivalent Terminology
Reactive cellular changes associated with inflammation /repair	Reactive cellular changes associated with inflammation /repair
Radiation	Radiation
Intrauterine contraceptive device	Intrauterine contraceptive device
Glandular cell status post hysterectomy	Endometrial cells in a post menopausal woman
Endometrial cells (in a woman >40year if age)	Glandular cell inconsistent with stated age and/ clinical status of woman

SQUAMOUS EPITHELIAL CELL ABNORMALITIES
2001 Bethesda System	Equivalent Terminology
Atypical squamous cells of undetermined significance (ASC-US) cannot exclude HSIL (ASC-H)	Borderline nuclear changes
Low grade Squamous intraepithelial lesions (LSIL) encompassing: HPV/mild dysplasia/CIN1	Mild dysplasia/CIN1 with or without HPV Mild dyskariosis suggestive of CIN1(with or without HPV)
High grade Squamous intraepithelial lesion (HSIL) encompassing: moderate and severe dysplasia, CIS, CIN2 and CIN3	Moderate dysplasia/ CIN2 Moderate dyskariosis suggestive of CIN2 Severe dysplasia/ CIS/ CIN3 Severe dyskariosis suggestive of CIN3
With features suspicious for invasion	Severe dysplasia/ ?invasive carcinoma Severe dyskariosis/ ?invasive carcinoma Suggests CIN3 but invasive carcinoma not excluded
Squamous cell carcinoma	Invasive Squamous cell carcinoma

GLANDULAR EPITHELIAL ABNORMALITIES
2001 Bethesda System	Equivalent Terminology
Atypical Endocervical cells (NOS or specify) Endometrial cells (NOS or specify) Glandular cells (NOS or specify)	Atypical glandular cells (NOS or specify type) Atypical glandular cells of uncertain significance ? glandular neoplasia
Atypical Endocervical cells (favour neoplastic) Glandular cells (favour neoplastic)
Endocervical adenocarcinoma in situ	Endocervical adenocarcinoma in situ Suggest adenocarcinoma in situ,invasive adenocarcinoma not excluded ?glandular neoplasia
Adenocarcinoma Endocervical Endometrial Extrauterine Not otherwise specified (NOS)	Adenocarcinoma Endocervical Endometrial Extrauterine Not otherwise specified (NOS)

IARC Handbooks of Cancer Prevention

Volume 10 Cervix Cancer Screening
Chapter 2: pp 59-67 historical revue of terminology used to describe cervical smears
Chapter 2: pp 69-74 comparison of conventional cytology with liquid based cytology

Further information relating to Bethesda

Specimen Adequacy AddendumB

HSIL LSIL Post Workshp

Endometrials Post Workshp

Specimen Adequacy Post Workshp

BCC Post Workshp

ASCUS Post Workshp

Ancillary Test Post Workshp

AGUS Post Workshp

AGUS Appendix Post Workshp

Computer Post Workshp