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May 2003
Special Section

Coming soon: new Bethesda System atlas and Web site

Ritu Nayar, MD
Diane Solomon, MD


A new edition of the Bethesda System atlas, widely known as the
“Blue Book,” will be published this fall and contain the Bethesda 2001 terminology. A companion Web site is also in the works.

The Bethesda System for reporting cervical cytology results was developed in 1988 and revised in 1991 and in 2001 (The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002;287[16]:2114-2118). Its intent is to provide clear, uniform terminology in communicating laboratory results that would also be relevant for guiding clinical management. A companion atlas, edited by Robert Kurman, MD, and Diane Solomon, MD, with several dozen contributors, was published in 1994 to illustrate and disseminate the morphologic criteria. The atlas is no longer current with the 2001 terminology, however, and the last decade has seen an increase in the use of liquid-based technologies for cervical cancer screening, which often yield different morphologic features from those of conventional smears.

To continue the tradition of making the Bethesda System terminology the product of an increasingly numerous and diverse group of contributors, the National Cancer Institute joined hands with the American Society for Cytopathology to help disseminate Bethesda 2001. The ASC executive board appointed an ad hoc task force in April 2002 to work in conjunction with Dr. Solomon at the NCI to undertake a new edition of the Bethesda System Blue Book and develop a Web-based atlas of images to complement the book version.

The Bethesda atlas will maintain its easy-to-read format with corresponding images, and the content will be divided into chapters based on the major Bethesda 2001 interpretive categories. The new edition will include liquid-based cytology, morphologic criteria, and images, and there will be new sections on ancillary testing, computer-assisted interpretation, and anal cytology. Included also will be sample reports, selected references, and an index as well as an educational notes and recommendations section.

At the same time the Bethesda 2001 atlas is being produced, the ASC task force is developing a companion Web site. The Web site will contain images from the new atlas and additional examples of Bethesda System interpretations, and pertinent explanatory notes will be linked to the images. The proposed Web site will allow global access to diagnostic images and individual self-assessment. It is scheduled to be available by fall of this year.

Dr. Nayar is director of cytopathology, Northwestern Memorial Hospital, Chicago, and chair of the ASC Bethesda 2001 Task Force. Dr. Solomon is a senior investigator at the NCI, organizer of the Bethesda workshops, and ASC past president. The NCI-ASC Working Group for Bethesda 2001 Atlas and Web Site is composed of members of the ASC Bethesda 2001 Task Force: George Birdsong, MD, adequacy; Jamie Covell, BS, CT (ASCP), glandular lesions; Ann Moriarty, MD, endometrial cells; Dennis O’Connor, MD, educational notes and recommendations; Marianne Prey, MD, computer-assisted interpretation; Steve Raab, MD, ancillary testing; Mark Sherman, MD, atypical squamous cells; Sana Tabbara, MD, other malignant neoplasms; Tom Wright, MD, squamous lesions; and Nancy Young, MD, non-neoplastic findings. ASC consultants are ASC 2002/2003 presidents Diane Davey, MD, and David Wilbur, MD. Information technology representatives are Mike Montgomery (NCI) and Brandon Winbush (Northwestern University).