2. Cervical Cancer Screening
Terminology
Equivalent terminologies
Squamous intraepithelial lesion (SIL)
Dysplasia
Intraepithelial lesion, specify location
Cervix : CIN
Vagina : VAIN
Vulva : VIN
Anus : AIN
Penis : PIN
Carcinoma–in–situ (CIS)
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3. Cervical Cancer Screening
Terminology
Bethesda System (2001) has been used to describe Pap
Smear Findings
Terminology for Pap smear interpretation is discrete
from terminology for biopsies (histology) of the lower
genital tract
Cytology: LSIL, HSIL
Histology: CIN 1, CIN 2, CIN 3, CIS
Cytological LSIL is not equivalent to histopathological
CIN I and cytological HSIL is not equivalent to
histopathological CIN 2 or 3
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4. Terminology (CYTOLOGY)
Bethesda System
Specimen Type
Conventional, ThinPrep, Other
Specimen Adequacy
Satisfactory for evaluation
Unsatisfactory due to (specify reason)
General Category
Negative for malignancy
Epithelial cell abnormality (squamous or glandular)
Other (see interpretation)
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5. Terminology - Bethesda System:
Interpretation: Negative
Absence of malignancy needs to be stated
Describe infection if present
Trichomonas, Candida, Actinomyces
Other Nonneoplastic findings
Reactive cellular changes
Glandular cells post hysterectomy
Atrophy
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6. Terminology - Bethesda System:
Interpretation: Other
Endometrial cells
In a woman over 40 years
Specify whether negative for squamous intraepithelial
lesion
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7. Terminology - Bethesda System:
Epithelial Cell Abnormalities: Squamous
Atypical Squamous Cells (ASC)
Of undetermined significance (ASC -US)
Cannot exclude High Grade Squamous
Intraepithelial Lesion (ASC -H)
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8. Terminology - Bethesda System:
Epithelial Cell Abnormalities: Squamous
Low Grade Squamous Intraepithelial Lesion (LSIL)
Cellular changes consistent with HPV, CIN 1, mild
dysplasia
High Grade Squamous Intraepithelial Lesion (HSIL)
Moderate to severe dysplasia, CIN 2, CIN 3, CIS
Indicate if features suspicious for invasion
Squamous Cell Carcinoma
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10. Terminology - Bethesda System:
Epithelial Cell Abnormalities
Other malignant neoplasms (specify)
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11. Terminology - PATHOLOGY
Lower Anogenital Squamous Terminology LAST
Project
Designed to comprehensively evaluate the terminology
of HPV associated lesions
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12. Terminology - PATHOLOGY
LAST Project Recommendations
Squamous Intraepithelial lesions
Superficially invasive squamous cell carcinoma
Biomarkers in HPV-associated lower anogenital
squamous lesions
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13. Terminology - PATHOLOGY
LAST Project Recommendations
Squamous Intraepithelial lesions
A unified histopathological nomenclature with a single
set of diagnostic terms for all HPV associated
preinvasive lesions
A two tiered nomenclature for noninvasive HPVassociated squamous proliferations
The terminology for HPV associated squamous lesions
of the lower anogenital tract is LSIL and HSIL (just as it
is for cytology)
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14. Terminology - PATHOLOGY
LAST Project Recommendations
Superficially invasive squamous cell carcinoma
(SISCCA)
SISCCA should be used for minimally invasive cancer is
defined as an invasive cancer that is
1) not visible
2) depth of invasion of <3 mm
3) horizontal spread < 7 mm
4) has been completely excised
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15. Terminology - PATHOLOGY
LAST Project Recommendations
Biomarkers in HPV-associated lower anogenital
squamous lesions
P16 immunohistochemistry staining is recommended
when unclear if CIN 2 or 3 versus nonmalignant
process such as reparative, squamous metaplasia
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17. Cytology
The Atypical Pap Smear
Definition
Abnormality in squamous or columnar cells in which the cells
show mild to moderate alterations in nuclear size and
morphology
Causes
Trauma
Infection
Intraepithelial neoplaisia
Cancer
Radiation
Chemotherapy
18. Cytology
Atypical Squamous Cells Uncertain Significance
3 to 10% of all screening Pap smears
10 to 40% risk of underlying intraepithelial lesion
Decreased estrogen results in increase ASCUS in
menopause
19. Atypical Squamous Cells
Pap Smear Diagnosis
ASC-US
50% will be positive for high risk HPV
5-7% presence of CIN 2-3
ASC-H
24-94% presence of CIN 2-3
25. Cytology
Glandular Lesions
LESIONS
NUMBER (% of 268 AGUS Pap Smears )
Premalignant squamous cervix
28 (10.4%)
Premalignant glandular cervix
13 (4.9%)
Adenocarcinoma of the cervix
7 (2%)
Endometrial hyperplasia
6 (2.2%)
Uterine cancer
12 (4.5%)
Metastatic adenocarcinoma
1 (0.4%)
TOTAL
67 (25%)
Kim et al; Gyn Oncol vol 73 p 292 (1999)
37. CERVICAL CANCER
SCREENING
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CONCLUSIONS
-The Bethesda system for pap smear reporting is reviewed.
-Lower Anogenital Squamous Terminology LAST Project is
discussed.
-Terminology for cytology and pathology are reviewed.