General Categorization in Bethesda System

The ‘general categorization’ is included as an optional component of the Bethesda System to allow clinicians to readily determine whether any degree of abnormality is present. With the 2001 Bethesda System, all cytology specimens are classified into one of three general categories.

These include ‘negative for intraepithelial lesion or malignancy’, ‘epithelial cell abnormalities’ and ‘other’. These categories are mutually exclusive and specimens should be categorized according to the most significant findings. ‘Negative for intraepithelial lesion or malignancy’ includes all specimens in which no intraepithelial lesion or malignancy is identified. This includes cases with common infections such as Trichomonas vaginalis, fungal organisms such as Candida species, Actinomyces or herpes simplex virus, a shift in bacterial flora consistent with bacterial vaginosis, reparative/reactive changes, changes associated with intrauterine devices, radiation reactions or atrophic changes.

The category ‘epithelial cell abnormalities’ includes both squamous and glandular cell abnormalities. This category is used whenever there are epithelial cell abnormalities, except for benign reactive or reparative changes.

The 2001 Bethesda System introduced a new general categorization, ‘other’. This category is used whenever there are no morphological abnormalities in the cells per se, but there are findings indicative that the woman is at some increased risk. An example is when benign appearing endometrial cells are identified in a woman 40 years of age or older.