Cervical cytology — Bethesda System quick review
Author: Faruk Skenderi, MD, PhDReviewed by: Semir Vranić, MD, PhDLast reviewed:
- Nayar R, Wilbur DC, eds. The Bethesda System for Reporting Cervical Cytology. 3rd ed. Springer; 2015.
- Nayar R, Wilbur DC. The Pap test and Bethesda 2014. Acta Cytol. 2015;59(2):121-132. https://doi.org/10.1159/000381842 (opens in new tab)
- Perkins RB, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020;24(2):102-131. https://doi.org/10.1097/LGT.0000000000000525 (opens in new tab)
A trainee-oriented refresher on the 2014 Bethesda System for reporting cervical cytology: specimen adequacy, NILM, ASC-US/ASC-H, LSIL, HSIL, AGC, and reporting pitfalls.
- Specimen adequacy requires ≥5,000 well-visualised squamous cells for liquid-based preparations (≥8,000–12,000 for conventional smears).
- ASC-US: equivocal changes suggestive of LSIL — reflex high-risk HPV testing drives management.
- ASC-H: cannot exclude HSIL — colposcopy is indicated regardless of HPV status.
- LSIL features: koilocytosis, mild dyskaryosis, nuclear enlargement (≥3× intermediate cell nucleus).
- HSIL features: high N:C ratio, hyperchromasia, irregular nuclear membranes, coarse chromatin.
- AGC: always specify origin (endocervical, endometrial, NOS) — high underlying neoplasia risk.