BSCC, Bethesda or other? Terminology in cervical cytology European panel discussion

Abstract

The European panel agreed that reproducibility and translatability of terminology in cervical cytology were essential, arguing well for harmonization of reporting systems. The majority at this meeting use a modification of the Bethesda system (BS). Local modifications involved reporting subcategories within high grade and low grade lesions, which would not alter the overall translatability of their systems both with each other and BS. The majority agree that low grade lesions with and without koilocytosis should be managed similarly as should high grade lesions (moderate dysplasia/CIN2 or worse). Those systems linking moderate dysplasia with mild rather than severe dysplasia would need to define moderate dysplasia as such, if their results were to be translatable, which would be preferable to their using a different definition of low grade and high grade lesions. Translation between systems might anyway be facilitated by reporting moderate dysplasia as a subcategory within high grade, which was favoured by most of those present. Therefore, there is no need for exact agreement of terminology if broad principles are agreed. This useful discussion adds weight to the British Society for Clinical Cytology recommendation that the new classification should be adopted by the UK National Health Service Cervical Screening Programme. If the new classification is adopted, the UK would join the European consensus opinion on terminology.

Reproducibility of Classification and Correction for Verification Bias as Determinants of Performance of Papanicolaou Smear Cytology in the Screening Setting

“…21 At the same time, several other European countries (Germany, the Netherlands, Switzerland, France, Italy) introduced even more complex modifications in the original Papanicolaou classification. 12,13 Thus, because this is not a unique problem confined to the NIS countries only, but has more widespread implications in standardization of Pap smear cytology at European level, [12][13][14][15] it was felt appropriate to run the present analysis to demonstrate how the different approaches to convert the Papanicolaou classification to TBS contribute to the performance of Pap test. In addition, because of an increasing interest recently focused on verification bias in cohort studies, 32,33 we wanted to demonstrate how correcting for the verification bias affects the performance indications of these 3 classifications (original, TBS1, TBS2).…”

“…[12][13][14][15]22,23,[25][26][27] This fact certainly hampers finding a common language and is one of the major obstacles for international standardization of this time-honored diagnostic tool. [4][5][6]14,15,21 These obstacles are well illustrated in the present study, in which performance of conventional Pap smear cytology as a screening tool was tested in low-resource settings of 3 NIS countries.…”

“…[1][2][3] Despite these undeniable merits, however, the conventional Pap smear also suffers from inherent flaws, as repeatedly emphasized during the past several years. [4][5][6] The problems recently ascribed to Pap smear cytology are due to several reasons, including (1) different technical modifications, [7][8][9] (2) divergent classifications used in different geographic regions (e.g., United States vs. Europe) [10][11][12][13][14][15] and (3) inherent suboptimal reproducibility as measured by intraobserver and interobserver variation in diagnosis. [16][17][18][19][20] The problems in conventional Pap smear cytology have prompted several active measures taken to counteract these inherent flaws in this traditional diagnostic tool.…”

“…[16][17][18][19][20] The problems in conventional Pap smear cytology have prompted several active measures taken to counteract these inherent flaws in this traditional diagnostic tool. Most important, these include technical innovations in the late 1990s leading to the development of liquid-based cytology techniques, 9 cytology automation [1][2][3]12,13 and rigorous quality control measures to improve the reproducibility. 7,8,15,18,[21][22][23][24][25][26] As part of our systematic efforts to improve the quality of conventional Pap smear cytology, 21,22,25,27 we recently developed laboratory software (CONQUISTADOR) to assist this intraobserver and interlaboratory quality assurance, validated in a simulation study 28 and recently shown useful in a screening setting ongoing in Latin America (the LAMS study).…”

Method comparison between Munich II and III nomenclature for Pap smear samples

“…A detailed and exact classification system is essential to take necessary actions needed for treating cytological findings. The Munich II system was criticized to link moderate with mild dysplasia (8,9 Ethics Committee Approval: Ethics committee approval was received for this study from the ethics committee of Luebeck University (#12-234).…”