DNA cytometry confirms the utility of the Bethesda System for the classification of Papanicolaou smears

R. Bollmann et al., DNA cytometry confirms the utility of the Bethesda System for the classification of Papanicolaou smears, CANC CYTOP, 93(3), 2001, pp. 222-228
Citations number
Categorie Soggetti
Oncology,"Onconogenesis & Cancer Research
Journal title
ISSN journal
0008-543X → ACNP
Year of publication
222 - 228
SICI code
BACKGROUND. Developed in 1989, the Bethesda System has largely replaced pre vious classifications of Papanicolaou (Pap) smears front the uterine cervix . The system is binary, dividing smears into two groups - low-grade, squamo us, epithelial lesions (LSIL) or high-grade, squamous, epithelial lesions ( HSIL). A third category, atypical squamous cells of undetermined significan ce (ASCUS), is used to classify minimal cellular changes that do not satisf y the criteria for the low- or high-grade categories. This study was design ed to confirm the utility of this binary division and to compare the result s with another classification system (the Munich II Nomenclature) that is n ot binary but contains three divisions or grades for dysplasia - low, inter mediate, and high. METHODS, Pap smears were obtained from 593 women with a cytologic diagnosis of dysplasia based on the Munich System. Smears were then classified by th e Bethesda System into LSIL or HSIL. Patients were followed for 2 years eit her with biopsy or repeat cytology. The initial smears were restained by th e Feulgen method, and ploidy was evaluated by interactive DNA cytometry. RESULTS. Of 241 cases of LSIL, 39% were diploid, 57% polyploid, and 4% aneu ploid, Of 352 cases classified HSIL, 4% were diploid, 17% polyploid, and 79 % aneuploid. After 2 years of follow-up, 2 of 108 patients who were biopsie d and who were originally classified as diploid progressed to cervical intr aepithelial neoplasia/ carcinoma in situ (CIN/CIS) whereas 109 of 217 patie nts who were aneuploid and biopsied were found to have CINIII/CIS. CONCLUSIONS, The two divisions of the Bethesda System, LSIL and HSIL, corre lated with ploidy as evaluated by cytometry. Aneuploidy was found to be use ful to separate cases of HSIL from those of LSIL as defined in the Bethesda System. Because of the binary division, use of a system with three divisio ns for dysplasia, such as the Munich II Nomenclature, creates a therapeutic dilemma because a single diagnostic category (usually the intermediate gra de) may contain both self-limiting and progressive lesions. DNA cytometry o f Pap smears was found to be useful as a routine procedure. Cancer (Cancer Cytopathol) 2001;93:222-228. (C) 2001 American Cancer Society.