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Pap test results decoded: What do your test results mean?
Every year, countless women receive the Pap test, a screening test used to detect precancerous changes in the cervix. However, the importance of understanding test results is often overlooked. The "Bethesda system" was first introduced in 1988 to standardize the reporting of Pap test results and has been revised several times in the following years. This article takes a closer look at the Bethesda system and how it can help women interpret their Pap test results.
What is the Bethesda system?
The Bethesda System for Reporting Cervical Cytology (TBS) is the mainstream system currently used to report cervical cytology diagnosis. It is named after Bethesda, Maryland, the site of a conference sponsored by the National Institutes of Health. The system provides a variety of standardized reporting categories, ranging from normal to abnormal results.
Abnormal Pap Test Results
Abnormal results include:
- Atypical squamous cells (ASC)
- Atypical squamous cells of undetermined significance (ASC-US)
- Atypical squamous cells - cannot exclude HSIL (ASC-H)
Low-grade squamous intraepithelial lesion (LSIL) High-grade squamous intraepithelial lesion (HSIL)- Squamous cell carcinoma
- Atypical Glandular Cells not otherwise specified (AGC-NOS)
- Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)
Adenocarcinoma in situ (AIS)
Analysis of different types of Pap test results
Low-grade squamous intraepithelial lesion (LSIL)
Low-grade squamous intraepithelial lesions (LSIL or LGSIL) usually represent mild cervical epithelial abnormalities and are usually caused by human papillomavirus (HPV) infection. LSIL-type findings can generally be managed with watchful waiting, as in most cases, they resolve on their own within two years. However, because there is a 12-16% chance that the condition will progress, your doctor may recommend further testing, such as a colposcopy.
High-grade squamous intraepithelial lesion (HSIL)
High-grade squamous intraepithelial lesions (HSIL or HGSIL) usually indicate moderate or severe cervical epithelial abnormalities. Approximately 20% of patients, if untreated, will develop invasive cervical cancer. Therefore, when the examination results show HSIL, further colposcopy and sample biopsy are usually required to evaluate the pathology of the abnormal tissue.
Glandular Cell Abnormalities (AGC)
Aberrant glandular cells (AGC) refer to abnormal glandular cells of uncertain significance, which require further colposcopy or endometrial biopsy to confirm the results. Adenocarcinomas may also arise from the endocervix or other sites, so patients should pay close attention to these results.
Bethesda system for thyroid nodules
Similarly, the Bethesda system is also used in reporting thyroid cytopathology. The system provides six reporting categories for thyroid fine-needle aspiration cytology (FNAC) and recommends different follow-up steps based on the results, such as repeat FNAC or surgical resection.
ConclusionFor malignant FNAC reports, the risk of cancer was as high as 93.7%, while the risk for suspicious reports was 18.9%.
Understanding the Pap test and the related Bethesda System reports can help women better understand their health status. As medical technology advances, this standardized reporting system will not only provide accurate diagnoses but also help patients make informed medical decisions. So, when faced with a medical report, are you ready to take a deeper look at your health and proactively ask your doctor about your options?
