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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.
In England, the NHS cervical screening programme is available to women aged 25 to 64; women aged 25 to 49 receive an invitation every 3 years and women aged 50 to 64 receive an invitation every 5 years to undergo HPV testing. [15] [16] If there is a positive HPV test result, then patients undergo further cytology (Pap smear). [15]
The Papanicolaou test (abbreviated as Pap test, also known as Pap smear (AE), [1] cervical smear (BE), cervical screening (BE), [2] or smear test (BE)) is a method of cervical screening used to detect potentially precancerous and cancerous processes in the cervix (opening of the uterus or womb) or, more rarely, anus (in both men and women). [3]
ThinPrep pap smear with group of normal cervical cells on left and HPV-infected cells showing features typical of koilocytes: enlarged (x2 or x3) nuclei and hyperchromasia. A koilocyte is a squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by human papillomavirus (HPV). [1]
Because HPV type 16 is the most common type found in oropharyngeal cancer, p16 immunohistochemistry is one test option used to determine if HPV is present, [135] which can help determine course of treatment since tumors that are negative for p16 have better outcomes.
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.
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.
A description of human papillomavirus (HPV) by electron microscopy was given in 1949, and HPV-DNA was identified in 1963. [165] It was not until the 1980s that HPV was identified in cervical cancer tissue. [166] It has since been demonstrated that HPV is implicated in virtually all cervical cancers. [167]