Responding to Bethesda system reports

OBJECTIVE To review the adequacy and diagnostic categories of the Bethesda system for reporting Pap test results (cervicovaginal cytology) and summarize management options. QUALITY OF EVIDENCE The latest research evidence and guidelines from both international and Canadian sources are reviewed. With a few exceptions, good evidence supports particular management approaches for each adequacy statement and diagnostic category. MAIN MESSAGE Women with unsatisfactory Pap smears should be re-examined and retested. Women with satisfactory smears and a diagnosis of “within normal limits” (WNL) or “benign cellular changes” (BCC) should be retested only at recommended screening intervals. Women with “satisfactory but limited by...” results and a diagnosis of WNL or BCC should have individualized follow up. Women with diagnoses of high-grade squamous intraepithelial lesions, atypical glandular cells of uncertain significance, or malignancy should have further investigation (colposcopy). Optimal management of asymptomatic women with normal cervices and reports of atypical squamous cells of uncertain significance or low-grade squamous intraepithelial lesions is still controversial. CONCLUSION Management of women following Pap tests is determined by both the adequacy of the test and diagnoses based on the results.