Re-evaluation of conventional cervical smears with particular reference to revised Bethesda system criteria: a 5 years blind retrospective and prospective study

  • Sumit Prakash Rathore Assistant professor , Department of Pathology ,Jhalawar Medical College ,Jhalawar,Rajasthan.
  • Manish Kumar Assistant professor , Department of Pathology, Jhalawar medical college ,Jhalawar
  • Rana K. Sherwani Professor, Department of Pathology, J.N.Medical College, A.M.U., Aligarh
Keywords: Pap smear, Bethesda System, premalignant lesions, malignant lesions.


Background: The revised Bethesda System of reporting Pap smears in addition to defining the diagnostic categories also develops criteria for determining the adequacy and quality of Pap smears.Methods: The present retrospective and prospective study was conducted in department of pathology after approval from institutional ethics committee which included retrospective cases from 2007 to 2009 and prospective cases from 2010 to 2011. Prospective cervical smears were stained by using Papanicolaou stain. After staining, slides were mounted, screened and reported by two consultant pathologists by both Conventional system and the 2001 Bethesda system. Smears which were already reported by the Conventional system were also reviewed retrospectively by the 2001 Bethesda system. Cytohistopathologic correlation was done wherever available.Result: Results on adequacy of the specimens showed 98.0% smears as satisfactory and 2.0% were found to be unsatisfactory for evaluation. Pap smear reporting by both the systems showed similar number of cases with inflammatory findings. 18.3% premalignant lesions were reported by the Conventional system but it was significantly higher (31.8%) when reviewed by the Bethesda system. Numbers of malignant lesions were found similar by both systems i.e. 3.6%.Conclusion: Reporting should be done by the Bethesda System as it improves producibility and helps in diagnose of various intraepithelial lesions and invasive lesions at an early stage and helps to manage them properly. DOI: 10.21276/APALM.987

Author Biography

Sumit Prakash Rathore, Assistant professor , Department of Pathology ,Jhalawar Medical College ,Jhalawar,Rajasthan.
Assistant professor , Department of Pathology ,Jhalawar Medical College ,Jhalawar,Rajasthan  


1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55(2):74-108.
2. Sankaranaryanan R, Buduk AM, Rajkumar R: Effective Screening Programmes for Cervical Cancer in low- and middle-income developing countries. Bull World Health Organ 2001;79(10): 954-62.
3. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence. Mortality and Prevalence Worldwide. IARC Cancer Base No. 5, version 2.0., Lyon: IARC Press 2004.
4. Canfell K, Sitas F, Beral V. Cervical cancer in Australia and the United Kingdom: comparison of screening policy and uptake, and cancer incidence and mortality. Med J Aust 2006;185:482-6.
5. Papanicolaou GN. Introduction of Pap smear in early detection of cervical malignancies. Am J Clin Path 1940;19:301-8.
6. National Cancer Institute Workshop. The 1988 Bethesda System for reporting cervical/vaginal cytological diagnoses. JAMA. 1989;262:931-34.
7. Ransdell JS, Davey DD, Zaleski S. Clinicopathologic correlation of the unsatisfactory Papanicolaou smear. Cancer Cytopathol 1997;81:139-43.
8. Dhruva GA, Agravat AH, Bhojani KR. Analyses of cervical cancer in Rajkot population : Electronic Journal of Pharmacology and Therapy 2011;4:15-20.
9. Ranabhat SK, Shrestha R, Tiwari M. Analysis of abnormal epithelial lesions in cervical Pap smears in Mid-Western Nepal: Journal of Pathology of Nepal 2011;1: 30-3.
10. Khan MS, Raja FY, Ishfaq G, Tahir F, Subhan F, Birjees MK et al. PAP Smear Screening for Pre-cancerous Conditions of the Cervical Cancer. Pak J Med Res 2005; 44:111-3.
11. Sherwani RK, Khan T, Akhtar K, Zeba A, Siddiqui FA, Rahman K et al. Conventional Pap Smear and Liquid Based Cytology for Cervical Cancer Screening – A Comparative Study: Journal of Cytology 2007;24(4):167-72..
12. Abdullah LS. Pattern of abnormal Pap smears in developing countries: A report from a large referral hospital in Saudi Arabia using the revised 2001 Bethesda System. Ann Saudi Med 2007; 27(4 ):268-72.
13. Shorey G, Shorey P, Kurien A, Joshi VR, Mallick AK. Can the use of ayer’s spatula and cytobrush in combination improve the adequacy of cervical smears: International Journal of Applied Biology and Pharmaceutical Technology 2011; 2(2):111-16.
14. Sankaranarayanan R, Thara S, A Sharma, Roy C, Shastri S, Mahe C, et al. Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen 2004;11:77-84.
Original Article