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GYN Guidelines Non-USA

European guidelines for quality assurance in cervical cancer screening: recommendations for cervical cytology terminology,(Cytopathology 2007, 18, 213–219)(external link)

The European guidelines for quality assurance in cervical cancer screening "...provides a framework that will allow different terminologies and languages to be translated into standard terminology based on the Bethesda system (TBS) for cytology while retaining the cervical intraepithelial neoplasia (CIN) classification for histology. This approach has followed extensive consultation with representatives of many countries and professional groups as well as a discussion forum published in Cytopathology (2005;16:113).

Additional references:
Jordan, J., Arbyn, M., Martin-Hirsch?, P., Schenck, U., Baldauf, J.-J., Da Silva, D., Anttila, A., Nieminen, P. and Prendiville, W. (2008), European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1. Cytopathology, 19: 342–354. doi:10.1111/j.1365-2303.2008.00623.x(external link)

Table 1
Classification of Munich (II), modified by Soost in 1989 5.

ClassCytological descriptionRecommendation
I Normal cells
II Regenerative cells, immature metaplastic cells, important degenerative or inflammatory changes, para- and hyperkeratinizing cells. Normal endometrial cells even after the menopause. cytological control if necessary (with or without anti-inflammatory or hormonal treatment)
III Important degenerative, iatrogenic or inflammatory changes of the cells where benignity or malignancy cannot be diagnosed with certainty even if the smear is adequately prepared. short-term cytological control if necessary after anti-inflammatory or hormonal treatment, or immediate histological control
IIID Mild to moderate dysplasia (CIN I and II) cytological control in 3 months
IIIG Abnormal cells of the glandular epithelium whose carcinomatous nature cannot be excluded with certainty; if possible with an indication of the endometrial, endocervical or extra-uterine origin of the cells. cytological or histological control
IVa Severe dysplasia or carcinoma in situ (CIN III) histological control
IVbSevere dysplasia or carcinoma in situ; invasive carcinoma not excluded histological control
VInvasive epidermoid carcinoma of the uterine cervix; adenocarcinoma, indicating if possible the endometrial, endocervical or extra-uterine origin of the cells. Other malignant tumours histological control


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