Atypical squamous cells: improvement in cytohistological correlation by the 2001 Bethesda System

Purpose of investigation: To evaluate the advantages of the 2001 Bethesda System over the 1991 Bethesda System in the management of atypical squamous cells.

Methods: The cytology files of the 8,748 patients were reviewed for diagnosis of atypical squamous cells of undetermined significance (ASCUS) at Zeynep Kamil Hospital. Seventy-two of the 259 smear specimens with the diagnosis of ASCUS were reviewed and reclassified according to Bethesda 2001.

Results: Of the 8,748 specimens, 259 (2.96%) were diagnosed as ASCUS. In re-evaluation of the 72 specimens according to the 2001 Bethesda system, the number of cervical smears with a diagnosis of atypical squamous cells (ASC) decreased to 21 in number. Of the 21 cervical smears with an ASC category, eight patients (38.1%) had high-grade intraepithelial squamous lesions (HSIL) and six (28.6%) had low-grade intraepithelial squamous lesions (LSIL) in histopathological specimens. The detection rates of squamous abnormalities (chi2 = 24.79, p < 0.0001) and high-grade squamous abnormalities (chi2 = 8.31, p = 0.0039) were significantly higher according to Bethesda 2001.

Conclusion: The 2001 Bethesda System seems to reduce the number of cervical smear diagnoses of ASC, without causing any impairment in the diagnosis of HSIL thus decreasing the number of unneccesary interventions like cervical biopsy and decreasing the cost, inconvenience, anxiety and discomfort.

Atypical squamous cells; 1991 Bethesda system; 2001 Bethesda system

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