Application of Bethesda system for conventional cervical cytology: a study of 340 cases

Lalji G. Valiya, Seema N. Baxi


Background: Cervical carcinoma is an important women’s health problem worldwide. The Bethesda system is a complete diagnostic system that recognizes the cytopathology report as a medical consultation. The aim of this study is to evaluate the abnormal cytological entities detected by cervical Pap smear, to classify the cytological findings according to the recently recommended Bethesda system and to discuss the significance of Pap smears screening programs.

Methods: A prospective study on conventional cervical cytology was performed including 340 women, 111 postmenopausal and 229 reproductive age group, attending the Gynaecologic out-patient department at a tertiary care hospital in Bhavnagar district of Gujarat state. Cytological findings including incidence of unsatisfactory smears, inflammatory smears and epithelial abnormalities were classified according to the Bethesda system 2001.

Results: Overall incidence of unsatisfactory smears was 9.4%, of squamous cell abnormality was 4.1% and of glandular cell abnormality was 1.2%. Highest frequency of epithelial cell abnormalities (squamous as well as glandular) was seen in 61-70 years age-group women (35.71%) and in women presented with complaints of post-menopausal bleeding (22.5%).

Conclusions: The study had shown a relatively low prevalence of epithelial abnormalities in cervical smears. The 2001 Bethesda system seems to reduce the number of cervical smear diagnoses of Atypical Squamous Cells (ASC), without causing any impairment in the diagnosis of High grade Squamous Intraepithelial Lesion (HSIL) thus decreasing the number of unnecessary interventions.



Screening, Pap smear, Cervical cancer, Squamous intraepithelial lesion

Full Text:



Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;29(2):207-25.

Murthy NS, Chaudhry K, Saxen S. Trends in cervical cancer incidence - Indian scenario. Eur J Cancer Prev. 2005;14(6):513-8.

Koss LG. The Papanicolaou test for cervical cancer detection: A Triumph and a tragedy. JAMA. 1989;261(5):737-43.

National Cancer Institute Workshop. The 1988 Bethesda system for reporting cervical/vaginal cytological diagnoses. JAMA. 1989;262(7):931-4.

Solomon D, Davey D, Kurman R, Moriarty A, O’Connor D, Prey M, et al. Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-9.

Malik SN, Wilkinson EJ, Drew PA, Hardt NS. Benign cellular changes in Pap smears: causes and significance. Acta Cytol. 2001;45(1):5-8.

Apgar BS, Zoschnick L, Wright TC Jr. The 2001 Bethesda system terminology. Am Fam Physician. 2003;68(10):1992-8.

Karateke A, Gurbuz A, Kabaca C, Zafi A, Mengulluoglu M, Kir G. Atypical squamous cells: Improvement in cytohistological correlation by the 2001 Bethesda system. Eur J Gynaecol Oncol. 2004;25(5):615-8.

Warner EA, Parson AK. Screening and early diagnosis of gynaecologic cancers. Med Clin North Am. 1996;80(1):45-61.

Costa MJ, Grimes C, Tackett E, Naib ZM. Cervicovaginal cytology in an indigent population: comparison of results for 1994, 1981 and 1989. Acta Cytol. 1991;35(1):51-6.

Gupta K, Malik NP, Sharma VK, Verma N, Gupta A. Prevalence of cervical dysplasia in western Uttar Pradesh. J Cytol. 2013;30(4):257-62.

National Cancer Institute Workshop. The Bethesda system for reporting cervical/vaginal cytologic diagnoses: revised after the second National Cancer Institute Workshop, April 29-30, 1991. Acta Cytol. 1993;37:115-24.

Henry MR. The Bethesda system 2001: an update of new terminology for gynaecologic cytology. Clin Lab Med. 2003;23(3):585-603.

Mulay K, Swain M, Patra S, Gowrishankar S. A comparative study of cervical smears in an urban Hospital in India and a population-based screening program in Mauritius. Indian J Pathol Microbiol. 2009;52:34-7.

Kavatkar AN, Nagwanshi CA, Dabak SM. Study of a manual method of liquid-based cervical cytology. Indian J Pathol Microbiol. 2008;51:190-4.

Vassilakos P, Saurel J, Rondez R. Direct-to-vial use of the AutoCyte PREP liquid-based preparation for cervical-vaginal specimens in three European laboratories. Acta Cytol. 1998;43(1):65-8.

Thamboo TP, Salto-Tellez M, Tan KB, Nilsson B, Rajwanshi A. Cervical cytology: an audit in a Singapore teaching hospital. Singapore Med J. 2003;44(5):256-60.

Mattosinho de Castro FMG, Dall’ Agnol M, di Loreto C, Pirani WM, Utagawa ML, Pereira SM, et al. One hundred percent rapid rescreening for quality assurance in a quality control program in a public health cytologic laboratory. Acta Cytol. 2005;49(6):639-43.

Elhakeem HA, AI-Ghamdi AS, AI-Maghrabi JA. Cytopathological pattern of cervical Pap smear according to the Bethesda system in South-Western Saudi Arabia. Saudi Med J. 2005;26(4):588-92.