In the past decade, since the publication of the second edition of the Bethesda Atlas in 2004, considerable experience has been gained with the use and impact of the Bethesda terminology for cervical cytology in clinical practice. This includes additional experience with morphology on liquid-based preparations, further insights into HPV biology, implementation of HPV vaccination, and updated guidelines for cervical cancer screening and the management of abnormal cervical cytology and cancer precursors.
Thus 2014 seemed to be the appropriate time for a review and update of the 2001 Bethesda System terminology and incorporation of revisions and additional information into this third edition of the Bethesda Atlas for cervical cytology.
Despite recent concern about the demise of the Papanicolaou test, as it gradually yields its role as a primary cervical cancer screening test to HPV and other biomarker testing, cervical cytology remains the most successful cancer prevention program ever devised. Its specifi city will remain the cornerstone of future screening regimens, including those in women who have received HPV vaccination.
Additionally, in many settings, cervical cytology will continue to be the fi rst line screening test based on resources and local preferences. Hence, updating and further refi nement of morphologic criteria for the great variety of entities seen in cervical cytology, both neoplastic and non-neoplastic, is an important function of this edition. Wide dissemination of this comprehensive and relatively inexpensive atlas will therefore serve to maximize the overall value of the test in all practice settings.
Since minimal changes were anticipated to the terminology recommended by the 2001 Bethesda System (TBS), there was no consensus workshop held in association with the 2014 Bethesda System update. Therefore, Dr. Ritu Nayar, President of the American Society of Cytopathology (ASC) in 2014, appointed a task force, chaired by Dr. David Wilbur (ASC President in 2002), which was comprised of a relatively small group of cytopathologists and clinicians/epidemiologists in order to expeditiously accomplish this task.
Following literature review and formulation of the proposed new and expanded content for the atlas, a widely advertised Internet-based public open comment period was initiated within the international cytopathology community for a 3.5-month period lasting from March through mid-June of 2014. A total of 2454 responses were received from individuals in 59 countries spread over a broad demographic, on proposals from each of the atlas’s 12 chapter-based surveys.
Excellent feedback was gathered on the proposed updates, which was compiled and reviewed by the chapter-based task force working groups. This process culminated in refi nement of positions and content, which were then incorporated into the 2014 Bethesda System and this accompanying atlas.