Bethesda System For Reporting Cervical Cytology Ebook Free 16

High grade squamous intraepithelial lesion (HSIL) is a squamous cell abnormality associated with human papillomavirus (HPV). It encompasses the previously used terms of CIN2, CIN3, moderate and severe dysplasia and carcinoma in situ. This current terminology for HSIL was introduced by the Bethesda System for Reporting Cervical Cytology (TBS) for cytology specimens in 1988, and has since been adopted for histology specimens by the Lower Anogenital Squamous Terminology Standardization Consensus Conference (LAST) [1] and the World Health Organization (WHO) in 2012 and 2014, respectively. Though not all HSIL will progress to cancer, it is considered a pre-cancerous lesion and therefore is usually treated aggressively. Though HSIL can involve various cutaneous and mucosal sites within the anogenital tract, this summary will focus on cervical HSIL

Diagnosis of HSIL on cytology requires specific criteria to be met. The cells are smaller with less cytoplasmic maturity than that of LSIL. Occasionally, the cytoplasm may be densely keratinized. HSIL cells occur singly as well as in sheets or syncytial aggregates. Though the size of the nucleus itself is variable, the cells must have a high nuclear-to-cytoplasmic ratio. The nuclei are often hyperchromatic but can be normo- to hyperchromatic. The chromatin can range from evenly distributed and fine to coarsely granular. Nuclear contours must be distinctly irregular with prominent indentations and/or grooves. Nucleoli are usually not a feature of HSIL, though may be seen when HSIL involves the endocervical glands.

bethesda system for reporting cervical cytology ebook free 16

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The current American Congress of Obstetricians and Gynecologists (ACOG) recommendations for cervical carcinoma screening in women is dependent upon age, HIV infection/immunodeficiency and pregnancy status. Screening should be initiated at 21 years of age. Women ages 21 to 29 should be screened by cytology every three years. Women ages 30 to 65 should be screened with cytology and HPV co-testing every five years or by cytology alone every three years. Depending on the HPV test used, the test will provide pooled results for high-risk HPV subtypes and/or individual genotype results for HPV16 and 18. The risk of HSIL in a patient with a positive HPV test and an abnormal pap test is approximately 20% and increases to 33% if HPV positive at more than one visit.[10]

A Papanicolaou (Pap) test is the preferred initial method of screening for cervical neoplasia. This is performed by opening the vaginal canal with a speculum, fully visualizing the cervix, using a cervical broom or spatula to exfoliate cells from the transformation zone and transferring the cells either into liquid preservative (liquid-based cytology) or directly onto a microscope slide (conventional cytology). Pathology will process the specimens according to the type of test they receive.

The American Society for Colposcopy and Cervical Pathology publishes guidelines for the management of woman based on their Pap test and HPV test results. For women ages 21-24, colposcopy is recommended following an HSIL cytology diagnosis. Women over the age of 24 years old should also have colposcopy performed, though management with an excisional procedure is acceptable. Around 60% of women with HSIL cytology will have at least CIN 2 on biopsy, with approximately 2% showing invasive cancer, though the latter is more likely in older women. Women over 30 years of age have an 8% 5-year risk of cervical cancer after a diagnosis of HSIL. Biopsies taken during colposcopy are examined by histology. [11]

Atypical squamous cells of undetermined significance (ASC-US) is a category of cervical epithelial cell abnormalities described by the Bethesda system for reporting cervical cytology. It refers to abnormal cytologic changes that are suggestive of the squamous intraepithelial lesion (SIL) but are qualitatively and quantitatively less than those of a definitive SIL diagnosis. Based on the patient's age and the estimated risk of possible underlying neoplastic lesions, an ASC-US report requires further follow-up by doing repeat cytology and HPV tests to guide the management of potential precancerous/cancerous cervical lesions. This activity reviews the evaluation and management of ASC-US and highlights the role of the interprofessional team in this process.

Objectives:Explain the term "ASC-US" and identify its etiology.Describe the diagnostic workup tests used to evaluate a patient with a cervical cytology report of ASC-US.Outline the management of a patient with a cervical cytology report of ASC-US, based on the most recent practice guidelines.Explain the importance of collaboration and communication among the interprofessional team to ensure a thorough evaluation and management of a patient with a cervical cytology report of ASC-US.Access free multiple choice questions on this topic.

Atypical squamous cells of undetermined significance (ASC-US) is a term used to report a category of cervical epithelial cell abnormalities described by the Bethesda system for reporting cervical cytology. It refers to abnormal cytologic changes that are suggestive of the squamous intraepithelial lesion (SIL) but are qualitatively and quantitatively less than those of a definitive SIL diagnosis.[1] The clinical significance of ASC-US is based on the fact that this cytology finding is suggestive of a varying degree of SIL. Nearly 10% to 20% of patients with ASC-US prove to have a varying degree of cervical intraepithelial neoplasia (CIN), which are distinctive precursor lesions of cervical squamous cell carcinoma.[2]

Though it has been previously theorized that alpha-1 antitrypsin deficiency may be a genetic predisposition, this is not yet confirmed.[16] Rather, ample scientific evidence suggests that certain high-risk Human papillomaviruses (hrHPV) cause over 90% of cervical cancers, with 50 to 73.8% attributed to HPV 16 strain and 12 to 16.4 % attributed to HPV 18.[17][18] The long-standing model of diagnosis has been by cytology using the Papanicolaou smear (Pap test) and biopsy, and most recently by liquid-based cytology (LBC).[19][20] Other methods of diagnosis include HPV DNA test and colposcopy.[21][22]

Visual inspection of the ectocervix is the new way of screening, with immediate results and successful treatment of most of the identified precancerous lesions.[25] Negative cervical cytology is reported as "negative for intraepithelial lesion or malignancy" (Negative/NILM). Squamous cell abnormalities that can be detected by cervical cytology include ASC-US, atypical squamous cells-high-grade cannot be excluded (ASC-H), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial session (HSIL), and invasive squamous cancer. Glandular cell abnormalities include atypical glandular cells (AGC), including endocervical and endometrial cells (not otherwise specified or favor neoplastic), endocervical adenocarcinoma in situ (AIS), and adenocarcinoma. This activity will improve the understanding of what ASC-US is and the implications and management of ASC-US diagnosis.[26][27][21][28]

Cervical cancer is not a sexually transmitted infection, but it develops from precursor lesions (CIN) that are predisposed by a persistent infection with a common sexually transmitted pathogen, the HPV. There are over 200 species of human papillomavirus. Researchers have identified 13 hrHPV viral strains that cause human cancers, of which HPV 16 and HPV 18 cause about 70 percent of cervical cancers, and more so in HIV-infected women.[29][30] The atypical squamous cells seen in cervical cytology may be related to HPV infection and neoplasia. They are just cytologic mimics caused by inflammation, air drying, atrophy with degeneration, and other artifacts. One study of the U.S. cervical screening programs showed about 50% of women with atypical squamous cells are infected with HrHPV. In contrast, the other noninfected women are not at increased cancer risk.[2]

Cervical cancer screening in women between the age of 21 and 65 years is supported by the American College of Obstetricians and Gynecologists (ACOG), American Cancer Society (ACS), U.S Preventive Services Task Force (USPSTF), and the U.S. Food and Drug Administration (FDA).[6][14] Studies have shown that regular and consistent screening of women for cervical cancer reduces invasive cervical cancer incidence and deaths.[7] Any sexually active woman presenting in the outpatient department with gynecologic or perianal symptoms, including abnormal vaginal bleeding, vaginal discharge, dysuria, or vaginal itching, should undergo triage testing.[44][34] Immunocompetent and asymptomatic women between the ages of 21 and 29 are to be screened once every three years by cytology alone. In the older age groups of 30 to 65 years, where HPV persistence may spell problems, HrHPV testing alone or co-testing (HrHPV and cytology) is also recommended every 5 years in addition to the option of screening by cytology alone every 3 years.[8][6][60] Screening is not recommended for women below age 21 because most HPV infections are transient or clear completely. Women older than 65 years can cease surveillance screening if they have consistently been previously negative.

"Atypical glandular cells (AGC)" is the term adopted by The Bethesda system of reporting cervicovaginal cytology.[1] The Bethesda reporting system was initiated for uniform reporting and overcame interobserver variability of cervicovaginal cytology in 1988.[2][1]

Endocervical adenocarcinoma is the second most frequent carcinoma of the cervix after Squamous cell carcinoma (SCC).[4] Endocervical adenocarcinoma accounts for about 15 to 20% of cervical cancers. The incidence is reported to be on the rise, and this is thought to be mainly because of the decreasing incidence of invasive SCC due to early recognition of these lesions by cytology screening. Carcinoma of the cervix accounts for approximately 10% of cancer diagnosis worldwide and approximately 8.5% of cancer-related deaths. Though the incidence of endocervical adenocarcinoma is less than squamous cell carcinoma of the cervix, it is associated with a worse prognosis. It is more predominant in developing countries. In the US, the adenocarcinoma of the cervix has increased in incidence and is associated with increased numbers of sexual partners, younger age of initiation of sexual activity, and nulliparity.[5] 2ff7e9595c