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THE BETHESDA SYSTEM AND EVALUATION OF LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION (LSIL)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

Histological view:

Report

Management of Initial Abnormal Pap Smear (LSIL Algorithm)

Cytological view:

Summary

THE BETHESDA SYSTEMThe Bethesda System was firstly introduced in 1988 and revised in 1991. The Bethesda System 2001 is an incremental change in the Bethesda System 1991 for reporting cervical or vaginal cytologic diagnoses. The Bethesda System 2001, includes specimen adequacy, general categorization and interpretation and result.

(Crothers B.A.,2005)BETHESDA FORM 1991 BETHESDA FORM 1991

Cytomorphology of LSIL / Mild Dysplasia / CIN 1

Pitfalls:

OPTIONALLOGO HERE

Dysplasia - Terms used to describe abnormal changes in the cell found on the cervix layer. Dysplasia stages are mild, moderate and severe according to the effect on the cervix layer.

(Mckinley,2009) Low Grade Intraepithelial Lesion (LSIL) refers to early changes in the size, shape and number of cells on the 1/3 of the cervix layer. LSIL also referred as:• mild dysplasia• mild dysplasia with HPV• cervical intraepithelial noeplasia (CIN 1)

General features:1) Polyglonal shaped cells occur singly or in sheets. 2) Abundant cytoplasm stains either basophilic or eosinophilic 3) Occasionally, there is a distinct cleared area surrounding the

nucleus (koilocytosis). (Solomon D., Nayar R., 2004)

References

1) The Bethesda System 2001 is a modification of Bethesda 1991 were based on extensive review of the Cervical Cancer Screening, including new methodology and technology.

2) LSIL in The Bethesda System 2001 describe a range of noninvasive squamous epithelial abnormalities, these include cytophatic effect by HPV and mild dysplasia (CIN 1)

3) LSIL can be missed diagnosed with ASCUS by few similar criteria 4) Management of patient with LSIL:

- repeat smear 3 to 6 month.- if the women have infected with HPV is recommended to done colposcopy with directed biopsies.

a) Satisfactory for evaluation: Endocervical cell or transformation zone cell seen or not seen.

b) Interpretation: Low Grade Squamous Intraepithelial Lesion (LSIL) / LSIL with HPV changes.

c) Suggestion: Repeat smear after 6 month. (Solomon D, Nayar R, 2004)

Management

1) Mild dysplasia are prone revert to normal than to progress to cancer according to a study. (National Cancer Institute 1999).

2) Mild dysplasia (LSIL) should have a repeat smear 6 month rather than colposcopy and biopsy procedure. (Josefson D, 1999)

(Solomon D, Nayar R, 2004)(Cibas E.S, Ducatman B.S, 2003)

1) Salomon D, Nayar R (2004), The Bethesda System for Reporting Cervical Cytology, 2nd .Ed.New York, Springer-Verlag.

2) Cibas E.S.,Ducation B.S. (2003), Cytology Diagnostic Principles and Clinical Correlates.

3) Crothes A. B. , (2005) The Bethesda System 2001: Update on Terminology and Application. Retrieved from www.labec.net/doc/bethesda ,on 30 September 2010

4) Mckinley (2009), Cervical Dysplasia, Retrieved from http://www.mckinley.uiuc.edu, on 29 September 2010.

5) Schlecht , N.F. et al (2003), HPV Infection and Time to Progression and Regression of Cervical Intraepithelial Neoplasia. Retrieved from http://www.jnci.oxfordjournals.org on 28 September 2010.

6) http://www.cytologystuff.com/indexwork.htm. Retrieved on 23 September 2010.7) http://www.asccp.com Retrieved on 24 September 2010.8) http://nih.techriver.net Retrieved on 24 September 2010.

THE BETHESDA 2001 THE BETHESDA 1991Ephitelial cell abnormalities- Squamous cell Atypical squamous cell

-Of undetermined significance (ASCUS) -Cannot exclude HSIL (ASC-H)

Low grade squamous intraepithelial lesion (LSIL) (encompassing: HPV/ mild dysplasia / CIN I)

Ephitelial cell abnormalities-Squamous cell Atypical squamous cell of undetermined significant (Qualify)Low grade squamous intraepithelial lesion

-Encompassing: Human papillomavirus (HPV)/mild dysplasia / CIN1 )

(Crothers B.A., 2005)

3) Women with HPV infection is a precursor lesions for the cervix to persist longer and progress more quickly to cancerous lesion than women with non HPV infection.

(Schlecht, N.F, 2003)

LSIL: comparison between Bethesda 1991 and 2001