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The Bethesda System. Impact on reporting cervicovaginal specimens and reproducibility of criteria for assessing
M E Sherman1, M Weinstein, M Sughayer
1Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Applying Bethesda System guidelines for specimen adequacy had minimal impact on cytopathology. Unsatisfactory rates were low, but inadequate endocervical component (IEC) rates varied, especially after certain procedures.
Area of Science:
- Cytopathology
- Gynecologic Pathology
Background:
- Specimen adequacy is crucial for accurate cytopathologic diagnosis.
- The Bethesda System provides guidelines for assessing specimen adequacy in gynecologic cytology.
Purpose of the Study:
- To evaluate the impact of implementing the Bethesda System guidelines for specimen adequacy on cytopathologic diagnosis.
- To assess the rates of unsatisfactory specimens and inadequate endocervical component (IEC).
- To determine the reproducibility of Bethesda criteria for assessing endocervical sampling.
Main Methods:
- Retrospective analysis of cytopathologic specimens over one year.
- Calculation of unsatisfactory and IEC rates.
- Evaluation of reviewer agreement on Bethesda criteria for endocervical sampling.
Main Results:
- The unsatisfactory rate was 1.3%.
- The IEC rate was 3.8%, with higher rates after cone biopsy (16.5%) or initial IEC smear (18.7%).
- Repeat specimens using an endocervical brush showed lower IEC rates (11.8%) compared to a spatula (29.4%).
- Three-way reviewer agreement for endocervical sampling was 75%.
Conclusions:
- Implementation of Bethesda System guidelines for specimen adequacy has minimal impact on cytopathologic reporting and practice.
- Repeat specimens lacking adequate endocervical component can be frequent in specific patient groups.
- Standardized criteria improve the reliability of assessing endocervical sampling.
Abstract:
This study examined the impact of applying the Bethesda System guidelines for specimen adequacy on cytopathologic diagnosis at the Johns Hopkins Hospital laboratory of cytopathology during a one-year period. Application of the Bethesda guidelines resulted in a 1.3% unsatisfactory rate. In addition, 3.8% of specimens were satisfactory but contained an inadequate endocervical component (IEC). Smears obtained after a cone biopsy or an initial IEC smear were IEC in 16.5% and 18.7% of cases, respectively. The IEC rate following an initial smear lacking an endocervical component was 11.8% in repeat specimens obtained with an endocervical brush as compared to 29.4% in those obtained with a spatula alone. The reproducibility of the Bethesda criteria for assessing endocervical sampling was evaluated by comparing the level of agreement between three independent reviewers examining 40 test cases. Three-way agreement was achieved in 75% of cases. Two-way agreement ranged from 80.0% to 87.5%. We conclude that implementation of the Bethesda System guidelines for assessing specimen adequacy should produce a minimal impact on cytopathologic reporting and gynecologic practice. Repeat specimens lacking an endocervical component may be encountered relatively frequently in certain subsets of patients.