Cervicovaginal smears classification by using The Bethesda System (TBS) 2001 A Clinicopathological, Cytopathological and Histopathological study

Toqa Jabbar Chkhaim Al- Refaee
Dr.Hussam Hasson Ali
Dr.Liqaa Ryadh Moosa

Cervical cancer is a preventable malignancy, yet every year over 530,000 women are diagnosed with and over 275,000 women die from the disease worldwide. The distribution of cases and deaths is commoner in low and middle income countries, which have 86% of the global cases and 88% of the total deaths. The bethesda system aims to simplify cervical smear reporting and make. To evaluate The Bethesda System (TBS) 2001 of cervicovaginal smear classification in the diagnosis of different pathologies seen in 360 women having different gynecological complaints attending Gynecology Consultation Clinic in AL-Kadhemiya teaching hospital. To compare the cytopathological findings with histopathological findings whenever recommended and possible. Patients, Materials & Methods The study is prospective. Cervicovaginal smears were obtained from 360 female patients with different gynecological complaints (aged 15-72 years) all were married and non pregnant. The study smears were taken from patients attending Gynecological Consultant Clinic in Al- Kadhimiya Teaching Hospital for the period from November 2011 to April 2012. The smears were stained by the Pap technique and evaluated using The Bethesda System (TBS) 2001 with special emphasis on premalignant lesions. Out of (71 patients) with abnormal cervical smear (AS), (17 patients) had punch biopsy, the rest of patients who need punch biopsy refused to do biopsy. The histopathological diagnosis was confirmed by review of two freshly prepared hematoxlin and eosin stained slides. Results Cytopathological results: according to The Bethesda System 2001, the cytological findings of epithelial cells abnormalities were as follows: LSIL, as a single entity, was the most common cytological abnormality 28 cases (39.43% of AS, 7.7% of studied group).  ASC includes 14 cases (19.71% of AS, 3.88% of studied group); which is subdivided into: • ASC-H includes 8 cases (11.26% of AS, 2.22% of studied group).
ASC-US includes 6 cases (8.45% of AS, 1.6% of studied group). AGC includes 11 cases (15.5% of AS, 3.05% of studied group). High- grade squamous intraepithelial lesion (HSIL), including: Cervical intraepithelial neoplasia II (CIN- II), Cervical intraepithelial neoplasia III (CIN-III), & Carcinoma in situ. This category includes (18) cases (25.36% of AS, 5% of studied group). Histopathological results: Punch biopsy had been done for 17 (23.95%) of patients with AS, with different cytological diagnosis. Three cases (16.6% of HSIL group) had punch biopsy, two cases (11.1% of HSIL, 2.8% of AS) diagnosed as CIN II, and one case (5.5% of HSIL, 1.4% of AS) diagnosed as severe chronic non specific cervicitis. Out of (28) cases of LSIL, nine cases (32.1%) and represent (12.7% of AS) underwent punch biopsy, eight cases (28.5% of LSIL, 11.25% of AS) diagnosed as severe chronic non specific cervicitis, and one case (3.6% of LSIL, 1.4% of AS) diagnosed as CIN I. Out of (8) cases of ASC-H, one case (12.5%) and represent (1.4% of AS), underwent punch biopsy and diagnosed as CIN I. Out of (11) cases of AGC, four cases (36.4%) and represent
(5.6% of AS), underwent punch biopsy and diagnosed as endocervical polyp. It has been shown that the age of patients in this study who had precancerous lesions had their age ranging from (30- 49) years. History of vaginal discharge or abnormal vaginal bleeding showed no obvious significant correlation with the risk of harboring cervical intraepithelial lesions of any grade. Conclusions The Bethesda system is of validity in providing a uniform format for cervical cytology report, which is intended to communicate clinically relevant information using standardized terminology. Minimal cytological abnormalities were more common than HSIL. LSIL, as a single entity, was the most common cytological abnormality.