Symposium part 2: Should the Bethesda System terminology be used in diagnostic surgical pathology?: Counterpoint

The criteria currently used for grading cervical intraepithelial neoplasia (CIN) are arbitrary and subjective with consequent considerable intra- and interobserver variability. None of the currently used criteria make a clear-cut case for changing terminology. The combination of CIN 2 and CIN 3 into a high-grade lesion is not supported by biologic behavior or HPV typing and leads to overtreatment. The various shifts in nomenclature over the last 50 years through the dysplasia, CIN, and Bethesda systems, although intellectually stimulating, have neither improved diagnostic accuracy nor patient management. On the contrary, they often caused confusion and duplication, leading to the common and ironic practice that several terminologies are now being used in an additive fashion. New diagnostic markers are on the horizon as a result of the rapid development in the areas of genomics and proteomics. It seems likely that specific molecular biomarkers will become available, allowing the consistent and accurate discrimination between those intraepithelial lesions that will ultimately become invasive from the vast majority of lesions that will regress or persist. It is preferable at this time to maintain the current three-tier system, which is well entrenched and accepted around the world, until a novel approach places the classification of cervical precursor lesions on a new and solid footing. Ideally, we will then have a single-tier system identifying reliably those lesions that have the potential to become invasive.