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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]
Bethesda system Category Description Risk of malignancy [19] Recommendation [19] I Non diagnostic/unsatisfactory – Repeating FNAC with ultrasound-guidance in more than 3 months II Benign (colloid and follicular cells) 0–3%: Clinical follow-up III
Cytopathology suspicious for Hürthle cell neoplasm (Bethesda category IV, rather than Hürthle cell hyperplasia), Pap stain. [3] While Hurthle cells can occur in healthy thyroid glands, [1] they are often associated with Hashimoto's thyroiditis [4] and Graves' disease. [2]
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.
Cytopathology suspicious for Hürthle cell neoplasm (Bethesda category IV, rather than normal or hyperplastic Hürthle cells), Pap stain. [6] Cytopathology cannot distinguish Hürthle cell adenoma from Hürthle cell carcinoma, which requires histopathologic sections to see transcapsular or vascular invasion.
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Bethesda originally referred to the Pool of Bethesda, a pool in Jerusalem, described in the New Testament story of the healing the paralytic at Bethesda.
Model of the pools during the Second Temple Period (Israel Museum). The Pool of Bethesda is referred to in John's Gospel in the Christian New Testament, in an account of Jesus healing a paralyzed man at a pool of water in Jerusalem, described as being near the Sheep Gate and surrounded by five covered colonnades or porticoes.