1. Home>
2. Specialties>
3. General Medicine>
4. Clinical Practice Guideline Watch

New Bethesda Terminology and Management Guidelines for Pap Smear Findings

HPV testing can be used to manage women whose Pap smears show evidence of ASC-US.

Efforts to improve terminology for reporting results of cervical cytology and to develop more effective algorithms for cancer diagnosis and treatment of women with abnormal Pap smears were initiated at 2 recent consensus conferences. Participants used electronic bulletin boards to communicate and to build consensus before the actual conferences.

Participants in the first conference updated the Bethesda terminology system and emphasized that screening results may include interpretations that will contribute to diagnoses. The category for atypical squamous cells (ASC) was retained in the new terminology, but this category was divided into ASC of undetermined significance (ASC-US) and those in which high-grade squamous intraepithelial lesions cannot be excluded (ASC-H). Other squamous cell and glandular cell categories remained unchanged.

In the second conference, participants noted that DNA testing for human papillomavirus (HPV) can be used to screen women with mildly abnormal Pap smears. Women with ASC-US findings can be managed by 2 repeat Pap smears at 4- to 6-month intervals, immediate colposcopy, or DNA testing for high-risk types of HPV. DNA testing is preferred when liquid-based cytology is used for screening. In most cases, women with ASC-H, low- and high-grade squamous intraepithelial lesions, and atypical glandular cells should undergo colposcopy.

Comment: These new guidelines differ substantially from previous guidelines. An editorialist noted that these articles should be required reading for all clinicians who provide care to women. I second that statement. Evidence in support of these changes has been chronicled recently (Journal Watch May 28 1999, and Journal Watch Mar 23 2001).

— Robert W. Rebar, MD

Published in Journal Watch General Medicine May 14, 2002

Citation(s):

Solomon D et al. The 2001 Bethesda system: Terminology for reporting results of cervical cytology. JAMA 2002 Apr 24; 287:2114-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Wright TC Jr et al. 2001 consensus guidelines for the management of women with cervical cytological abnormalities. JAMA 2002 Apr 24; 287:2120-9.

• Original article (Subscription may be required)
• Medline abstract (Free)

Stoler MH. New Bethesda terminology and evidence-based management guidelines for cervical cytology findings. JAMA 2002 Apr 24; 287:2140-1.

• Original article (Subscription may be required)
• Medline abstract (Free)