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The Bethesda system (TBS), officially called The Bethesda System for Reporting Cervical Cytology, is a system for reporting cervical or vaginal cytologic diagnoses, [1] used for reporting Pap smear results. It was introduced in 1988 [2] and revised in 1991, [3] 2001, [1] [4] [5] and 2014. [6]
LEEP cone biopsy displaying normal cervical epithelium (far left) progressing to borderline koilocytosis, to LSIL, and to HSIL (far right). A squamous intraepithelial lesion (SIL) is an abnormal growth of epithelial cells on the surface of the cervix, commonly called squamous cells.
Among the Bethesda results: Low-grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesion (HSIL). An LSIL Pap may correspond to CIN1, and HSIL may correspond to CIN2 and CIN3, [67] but they are results of different tests, and the Pap test results need not match the histologic findings. [medical citation needed]
The cause of CIN is chronic infection of the cervix with HPV, especially infection with high-risk HPV types 16 or 18. It is thought that the high-risk HPV infections have the ability to inactivate tumor suppressor genes such as the p53 gene and the RB gene, thus allowing the infected cells to grow unchecked and accumulate successive mutations, eventually leading to cancer.
D. Squamous cell carcinoma, infiltrating the stroma (middle and left in image), and HSIL (right in image) Epithelial dysplasia , a term becoming increasingly referred to as intraepithelial neoplasia , is the sum of various disturbances of epithelial proliferation and differentiation as seen microscopically.
LEEP cone biopsy displaying normal cervical epithelium (far left) progressing to borderline koilocytosis, to LSIL, and to HSIL (far right). In LSIL of the cervix, definitive koilocytes are present. In addition, squamous cells commonly display binucleation and mitoses are present, signifying increased cellular division. [ 7 ]
Since Roosevelt, most presidents have used a military hospital close to Washington, D.C., either Bethesda or Walter Reed AMC, as the primary facility for their medical care and that of their immediate family. President Lyndon B. Johnson was a patient at the medical center several times during his presidency.
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