Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Study of Specimen Adequacy according to the Bethesda System 2001 Classification in Conventional Pap Smears from Patients Referred to Beheshti Hospital, Isfahan, Iran

Document Type : Original Article (s)

Authors
Fereshteh Mohammadizadeh 1
Najmeh Taban 2
1 Associate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Pap smear is an easy and cost-effective screening method for cervical carcinoma and its precursors. The Bethesda system 2001 for reporting cervicovaginal cytology provides valuable information about specimen adequacy. In the present study, we investigated the status of specimen adequacy in Pap smears taken from women who had referred to Beheshti Hospital in Isfahan, Iran.Methods: In this cross-sectional study, all women with Pap smears in Beheshti Hospital in a 6-month period were evaluated. Exclusion criteria were the history of previous cervical cone biopsy or total hysterectomy. The specimens were studied by the investigators using a two-headed microscope and their adequacy was classified according to the Bethesda system 2001.Findings: Overall, 99.1% of the 1420 investigated specimens were satisfactory. Moreover, 60% of partially obscured and 46.2% of unsatisfactory specimens had been obscured by excessive thickness. Conclusion: The results of this study showed that a considerable percentage of Pap tests are satisfactory for evaluation. Excessive thickness was found to be the most frequent obscuring factor in this study. Since this obscuring factor happens during smear preparation, training is helpful in reducing its frequency.
Keywords
Pap smear
Satisfactory smear
Unsatisfactory smear
The Bethesda system 2001
  1. Brant J. Cervical cancer. In: Miaskowski J, Buchsel P, editors. Oncology Nursing.New York: Mosby; 1999. p. 657.
  2. Status of Cervical Cancer Screening in Iran. Office of Family Health. Tehran: Proliferation Research Ministry of Health and Medical Education; 2000.
  3. Molodysky E, Bridges-Webb C. Sampling techniques for cervical cancer prevention. Aust Fam Physician 1996; 25(11): 1731-6.
  4. Felix J. Liquid- based thin-layer cytology. In: Apgar BS, Brotzman GL, Spitzer M, Ignatavicius D, editors. Colposcopy: Principles and Practice: An Integrated Textbook and Atlas. 1st ed. Philadelphia: Saunders; 2002. p. 56-72.
  5. McGoogen E. New technologies in cervical screening. In: Gray W, McKee GT, editors. Diagnostic Cytopathology. 2nd ed. Churchill Livingstone; 2003. p. 755-6.
  6. Nuovo J, Melnikow J, Howell LP. New tests for cervical cancer screening. Am Fam Physician 2001; 64(5): 780-6.
  7. Martin-Hirsch P, Lilford R, Jarvis G, Kitchener HC. Efficacy of cervical-smear collection devices: a systematic review and meta-analysis. Lancet 1999; 354(9192): 1763-70.
  8. Dey P, Collins S, Desai M, Woodman C. Adequacy of cervical cytology sampling with the Cervex brush and the Aylesbury spatula: a population based randomised controlled trial. BMJ 1996; 313(7059): 721-3.
  9. Davey DD. Cervical cytology classification and the Bethesda System. Cancer J 2003; 9(5): 327-34.
  10. Henry MR. The Bethesda System 2001: an update of new terminology for gynecologic cytology. Clin Lab Med 2003; 23(3): 585-603.
  11. Cibas E S. Cervical and vaginal cytology. In: Cibas ES, Ducatman BS, editors. Cytology: Diagnostic Principles and Clinical Correlates. 3rd ed. Philadelphia: Saunders; 2009. p. 9-10.
  12. Solomon D, Nayar R, Davey DD, Wilbur DC, Kurman RG. The Bethesda System for Reporting Cervical Cytology: Definitions, Criteria, and Explanatory Notes. 2nd ed. New York; 2004. p. 1-34.
  13. Davey DD, Neal MH, Wilbur DC, Colgan TJ, Styer PE, Mody DR. Bethesda 2001 implementation and reporting rates: 2003 practices of participants in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology. Arch Pathol Lab Med 2004; 128(11): 1224-9.
  14. Renshaw AA, Friedman MM, Rahemtulla A, Granter SR, Dean BR, Cronin JA, et al. Accuracy and reproducibility of estimating the adequacy of the squamous component of cervicovaginal smears. Am J Clin Pathol 1999; 111(1): 38-42.
  15. Selvaggi SM, Guidos BJ. Endocervical component: is it a determinant of specimen adequacy? Diagn Cytopathol 2002; 26(1): 53-5.
  16. Davey DD, Austin RM, Birdsong G, Buck HW, Cox JT, Darragh TM, et al. ASCCP patient management guidelines: Pap test specimen adequacy and quality indicators. Am J Clin Pathol 2002; 118(5): 714-8.
  17. Laverty CR, Farnsworth A, Thurloe JK, Bowditch RC. The importance of the cell sample in cervical cytology: a controlled trial of a new sampling device. Med J Aust 1989; 150(8): 432-4, 436.
  18. Keshavarz M. Effect of training on non-satisfactory results of Pap tests in Shahroud health centers. Proceedings of 5th International Congress of Obstetrics and Gynecology, Iran University of Medical Sciences and Health Services; 2003 Dec 8-11; Tehran, Iran.
  19. Treacy A, Reynolds J, Kay EW, Leader M, Grace A. Has the ThinPrep method of cervical screening maintained its improvement over conventional smears in terms of specimen adequacy? Diagn Cytopathol 2009; 37(4): 239-40.
  20. Shahpourian F, Molla Ahmadi L, Feizi Z, Hosseini F. A comparison of adequacy of cervical cytology sampling with cervix brush and modified ayre spatula: a two-group. Razi Journal of Medical Sciences 2006; 13(51): 139-48.
  21. Izadi Mood N, Dehdashti MR, Eftekhar Z, Ahmadi SA. The specimen adequacy and Atypical Squamous Cell frequency: conventional versus liquid-based cytology pap smears. Tehran University Medical Journal 2009; 66(12): 900-6.
Journal of Isfahan Medical School
Volume 29, Issue 171 - Serial Number 171
November and December 2012
Pages 2756-2764

  • Receive Date 04 December 2011
  • Accept Date 06 April 2022