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The Bethesda system for classification of Pap smears: The clinical experience of one cancer screening center

Since the initiation of the Bethesda System for the classification of cervical/vaginal cytology in 1988, anecdotal reports suggest that there may be an increased number of referrals for abnormalities. The purpose of this retrospective chart review (n = 533) was to describe (a) the adequacy of samples collected by an advanced practice nurse; (b) a comparison of the findings and referrals from Pap smears collected using the old numerical (I- V) system and the Bethesda system; and (c) findings from the follow-up of referrals of nonspecific Pap smears. A total of 108 smears were interpreted using the numerical system and 425 in the Bethesda System. Results included that 90% of the specimens were considered adequate for interpretation. Recommendations for repeat smears in women with nonspecific results were made to 128 women; 68 (53%) had a repeat Pap smear done. Of these women, 39 (57%) had a normal smear on repeat and 29 (43%) had a persistent nonspecific smear. When the numerical system was used, <10% were referred for a repeat smear or further evaluation. In this study, there appears to be an increase in the number of referrals for further evaluation with the use of the Bethesda system. Nurses need to consider various ways to educate women regarding the changes due to the Bethesda system and the clinical implications of the new system.