Sherman M E, Schiffman M H, Erozan Y S, Wacholder S, Kurman R J
School of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205.
Arch Pathol Lab Med. 1992 Nov;116(11):1155-8.
In the Bethesda System, noninvasive squamous abnormalities are classified as atypical squamous cells of undetermined significance (ASQUS), low-grade squamous intraepithelial lesions, and high-grade squamous intraepithelial lesions. The Bethesda System eliminates two diagnostic distinctions that are made in the dysplasia/carcinoma in situ and cervical intraepithelial neoplasia (CIN) classifications, CIN1 vs koilocytotic atypia and CIN2 vs CIN3, and maintains three others, negative vs ASQUS, ASQUS vs koilocytotic atypia, and CIN1 vs CIN2. To determine whether the diagnostic distinctions preserved in the Bethesda System are made more consistently than those eliminated, we analyzed the interobserver reproducibility of two cytopathologists in classifying 257 smears. The findings indicate that the distinctions retained in the Bethesda System are more reproducible than those eliminated. Specifically, cases classified as koilocytotic atypia were distinguished from CIN1 no more reproducibly than predicted by chance, whereas CIN2 and CIN3 were distinguished as consistently as any other pair of diagnoses examined. In 13 cases in which there was interobserver discordance, one reviewer classified the smear as ASQUS and the other reviewer diagnosed CIN2 or CIN3. The findings in this study suggest that smears showing koilocytotic atypia and/or CIN1 may be reported as low-grade squamous intraepithelial lesions without further specification. In contrast, smears showing high-grade squamous intraepithelial lesions may be further classified as CIN2 or CIN3 in accordance with the Bethesda guidelines. Since the diagnosis of ASQUS is applied to smears showing a wide spectrum of changes, management of patients with the diagnosis of ASQUS will be facilitated by providing an explanatory note and/or recommendations when appropriate.
在贝塞斯达系统中，非侵袭性鳞状上皮异常被分类为意义不明确的非典型鳞状细胞（ASC-US）、低级别鳞状上皮内病变和高级别鳞状上皮内病变。贝塞斯达系统消除了在发育异常/原位癌及宫颈上皮内瘤变（CIN）分类中所做的两项诊断区分，即CIN1与挖空细胞非典型性、CIN2与CIN3，同时保留了另外三项区分，即阴性与ASC-US、ASC-US与挖空细胞非典型性以及CIN1与CIN2。为了确定贝塞斯达系统中保留的诊断区分是否比被消除的区分更具一致性，我们分析了两位细胞病理学家对257份涂片进行分类时的观察者间重复性。研究结果表明，贝塞斯达系统中保留的区分比被消除的区分更具可重复性。具体而言，被分类为挖空细胞非典型性的病例与CIN1的区分，其可重复性并不比随机预测的更高，而CIN2和CIN3的区分与所检查的任何其他诊断对一样具有一致性。在13例观察者间存在分歧的病例中，一位审阅者将涂片分类为ASC-US，而另一位审阅者诊断为CIN2或CIN3。本研究的结果表明，显示挖空细胞非典型性和/或CIN1的涂片可报告为低级别鳞状上皮内病变，无需进一步说明。相比之下，显示高级别鳞状上皮内病变的涂片可根据贝塞斯达指南进一步分类为CIN2或CIN3。由于ASC-US的诊断适用于显示广泛变化的涂片，因此在适当的时候提供解释性说明和/或建议将有助于对诊断为ASC-US的患者进行管理。
