CYT 2113 Cytology I

Lesson 11

The Bethesda System II

Automated review

If the case is examined by an automated

device, indicate whether the scanning was

successful, the device and the manufacturers

name

Computer Assisted Interpretation

of Cervical Cytology

The type of instrumentation used should be

provided in the report

Data generated from screening devices that

are not intended for patient care, but may be are not intended for patient care, but may be

used for internal laboratory quality assurance,

should not be included in the report

Whether or not the specimen was successfully

processed by the device, regardless of the

result, should be reported

If the automated screening provides an

interpretation of the specimen that replaces

manual screening/review, then the result and

any adequacy data derived from the computer

assessment should be stated in the report assessment should be stated in the report

If there is no manual screening, i.e. automated

primary screening only, then, in general, no

name should appear on the report that can be

misconstrued as a person who examined the

slide

Results generated by the instrument must be

reviewed and verified by a laboratorian with

appropriate training and authorization

A record of who performed this data

verification should be maintained as an verification should be maintained as an

internal laboratory record

If a specimen is manually screened or

reviewed following automated screening, then

the results of both methods must be

compared and any discrepancy reconciled

Ancillary testing

Include the method (name and brief description)

used for reflex human papillomavirus (HPV) test

Results for reflex HPV test can be reported as:

A result only

As a result with a recommendation for clinical As a result with a recommendation for clinical

management

As a result plus the probability of an associated

dysplasia

As a definitive interpretation that reflects both

the cytomorphology and the HPV status

Interpretation/Result

Negative for intra-epithelial lesion or

malignancy

When there is no cellular evidence of

neoplasia, state this in the General neoplasia, state this in the General

Categorization previously mentioned and/or in

the Interpretation/Result section of the

report, indicate whether or not there are

organisms or other nonneoplastic findings

Organisms

Trichomonas vaginalis

Fungal organisms morphologically consistent

with Candida spp.

Shift in flora suggestive of bacterial vaginosis

Bacterial morphologically consistent with Bacterial morphologically consistent with

Actinomyces spp.

Cellular changes consistent with herpes

simplex virus

Individual squamous cells covered by a layer

of bacteria that obscures the cell membrane

(clue cells)

NILM: cellular changes consistent with Herpes

simplex virus. Nuclei showing ground-glass

appearance. Multinucleation and dense

eosinophilic intranuclear inclusions surrounded by a

halo are also seen

Other non-neoplastic findings

Reactive cellular changes associated with:

Inflammation (includes typical repair)

Radiation

Intrauterine contraceptive deviceIntrauterine contraceptive device

Glandular cells status post-hysterectomy

Atrophy

NILM: Reactive cellular changes associated with

radiation

Cells with enlarged nuclei, abundant vacuolated

polychromatic cytoplasm, mild nuclear

hyperchromasia without coarse chromatin,

prominent nucleoli

NILM: Atrophy

Parabasal cells with occasional pyknotic

degenerated cells. Globular collections of

basophilic amorphous material (blue blobs) present

Other

Endometrial cells after age 40, particlularly

out of phase or after menopause may be

associated with benign endometrium,

humoral alterations and less commonly,

endometrial/uterine abnormalitiesendometrial/uterine abnormalities

Clinical correlation is recommended

Endometrial Cells

Epithelial cell abnormalities

Squamous cell

Atypical squamous cells of undetermined

significance

Atypical squamous cells cannot exclude high-Atypical squamous cells cannot exclude high-

grade squamous intra-epithelial lesion

Low-grade squamous intra-epithelial lesion,

encompasses HPV/mild dysplasia/cervical

intra-epithelia neoplasia (CIN) 1

High-grade squamous intra-epithelia lesion,

encompasses moderate-to-severe dysplasia,

CIN 2, CIN 3/carcinoma in situ

Suspicious for invasive squamous-cell Suspicious for invasive squamous-cell

carcinoma

Squamous-cell carcinoma

Glandular cell

Atypical

Glandular cells

Endocervical cellsEndocervical cells

Endometrial cells

Atypical

Endocervical cells, favour neoplastic

Glandular cells, favour neoplastic

Endocervical adenocarcinoma in situ

Adenocarcinoma

Endocervical

EndometrialEndometrial

Extrauterine

Other malignant neoplasms

Includes sarcoma, malignant lymphoma and

others

Atypical Squamous Cells

ASC-H

Metaplastic cells with enlarged nuclei and

nuclear contour irregularities showing

variation in size, shape and ratio of nuclear

to cytoplasmic area

Epithelial Abnormalities: Squamous

LSIL

HPV nuclear and cytoplasmic changes (binucleation

and koilocytosis) are consistent with LSIL

HSIL. Severely dysplastic cells on the left

display a high nuclear to cytoplasmic ratio and

irregular nuclear membranes. Moderately

dysplastic cells on the right have similar nuclei

and more cytoplasm.

HSIL.

Isolated abnormal cells with evenly distributed

coarse chromatin, centrally placed enlarged

nuclei, and dense / metaplastic cytoplasm

are consistent with HSIL

Epithelial Abnormalities: Glandular

Atypical endocervical cells

Sheet of cells with enlarged round or oval

nuclei. Cell borders are well-defined. Mitotic

figures are noted.

Other Malignant Neoplasms

Other malignant neoplasms: metastatic gastric

carcinoma

A clean background is a common finding

compatible in metastatic rather than primary

tumours of the cervix

Other malignant neoplasms: sarcoma

Single giant cells with malignant nuclear features is

present in a bloody background.

Educational Notes and Suggestions

Suggestions are optional

Should be carefully crafted, concise and

consistent with published clinical follow-up

guidelines

Examples where educational notes may be used: Examples where educational notes may be used:

Negative cytology reports to highlight the

limitations of cervical cytology

Alerting clinicians to references containing

consensus guidelines published by different

professional organizations

Examples where suggestions may be useful:

On unsatisfactory specimens: to improve the

quality of a repeat specimen

To identify patients with cytologic findings that

may require further triage and management

When morphologic findings are ambigous When morphologic findings are ambigous

In complex cases, if direct contact with provider is

not feasible, general statements such as suggest

follow-up as clinically indicated or further

patient follow-up procedures are suggested as

clinically indicated can be used