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2 SPECIMEN TYPE: Indicate conventional smear (Pap smear) vs. liquid-based vs. other SPECIMEN ADEQUACY Satisfactory for evaluation (describe presence or absence of endocervicalitransformation zone comnonent and any other quality, indicators, e.g., partially obscuring blood, inflammation, etc) Unsatisfactory for evaluation... (specify reason) Specimen reiected/not processed (specify reason) Specimen processed and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify reason) GENERAL CATEGORIZATION (options Negative for Intraepithelial Lesion or Malignancy Epithelial Cell Abnormality: See Interpretation/Result (specify 'squamous' or 'glandular as appropriate) Other: See Interpretation/Result (e.g. endometrial cells in a woman.> 40 years of age) AUTOMATED REVIEW If case examined by automated device, specify device and result. ANCILLARY TESTING Provide a brief description of the test methods and report the result so that it is easily understood by the clinician. INTERPRETATION/RESULT NEGATIVE FOR INTRAEPITHELIAL LESION OR MALIGNANCY (when there is no cellular evidence of neoplasia, state this in the General Categorization above and/or in the Interpretation/Result section of the report, whether or not there are organisms or other non-neoplastic findings) ORGANISMS: Trichomonas vaainalis Fungal organisms morphologically consistent with Candida spp Shift in flora suggestive of bacterial vaginosis Bacteria morphologically consistent with Actinomyces spp. Cellular changes consistent with Herpes simplex virus OTHER NON-NEOPLASTIC FINDINGS (Optional to report; list not inclusive): ƒ Glandular cells status post hysterectomy Atrophy OTHER Endometrial cells (in a woman> 40 years of age) (Specify if 'negative for squamous intraepithelial lesion') EPITHELIAL CELL ABNORMALITIES SQUAMOUS CELL Atypical squamous cells -of undetermined significance (ASC-US) -cannot exclude HSIL (ASC-H) Low grade squamous intraepithelial lesion (LSIL) encompassing: HPV/mild dysplasia/cin 1 High grade squamous intraepithelial lesion (HSIL) ncompassing: moderate and severe dysplasia, C1S/C1N 2 and C1N 3 -with features suspicious for invasion (if invasion is suspected) Squamous cell carcinoma GLANDULAR CELL Atypical -endocervical cells (NOS or specify in comments) -endometrial cells (NOS or specify in comments) -glandular cells (NOS or specify in comments) Atypical -endocervical cells, favor neoplastic -glandular cells, favor neoplastic Endocervical adenocarcinoma in situ Adenocarcinoma -endocervical -endometrial -extrauterine -not otherwise specified (NOS) OTHER MALIGNANT NEOPLASMS: (specify) EDUCATIONAL NOTES AND SUGGESTIONS (optional) Suggestions should be concise and consistent with clinical follow-up guidelines published by professional organizations (references to relevant publications may be included).

4 and examined, but unsatisfactory for evaluation of epithelial abnormality because of (specify reason)].

6 1) Sheets and clusters of tightly packed glandular cells (hyperchromatic crowded groups) with crowding and overlap of nuclei; typical endocervical "honeycomb" pattern is lost 2) Specific architectural features including: pseudostratified strips of columnar epithelial cells, epithelial rosettes, nuclear protrusion at group margins (feathering) is often the most prominent architectural feature 3) Higher than normal nucleus to cytoplasmic ratios 4) Nuclear enlargement (75 um' mean) with pleomorphism of nuclear size and nuclear irregularity; elongation of nuclei is common 5) Distinctive coarsely granular, evenly distributed chromatin pattern 6) Nucleoli are not typically prominent 7) Mitoses and apoptotic bodies may often be present 8) Tumor diathesis is not typically present, however an inflammatory background is can be present 1) Hyperchromatic crowded groups become denser and more three dimensional with greater nuclear overlap, increased apparent hyperchromasia of nuclei, and with increased difficulty in visualization of individual nuclei in the groupings 2) "Disordered honeycomb" arrangement may be the only feature present in some cases 3) Key architectural features may be more subtle than in conventional smears 4) Margins of the groups become smoother and sharper with lesser degrees of nuclear protrusion (feathering) 5) Pseudostratified strips of cells are often the most prominent architectural arrangement

8 1) Solomon D, Frable WJ, Vooijs GP, Wilbur DC, Amma NS, Collins RJ, Davey DD, Knight BK, Luff RD, Meisels A, Navin J, Rosenthal DL, Sauer T, Stoler M, Suprun HZ, Yamauchi K. ASCUS and AGUS criteria. International Academy of Cytology Task Force summary. Di- agnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial. Acta Cytol Jan-Feb; 42 (1): 16 `24. 2) Solomon D, Schiffman M, Tarone R. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst Feb 21; 93 (4): 293 `9. 3) Bergeron C, Jeannel D, Poveda J, Cassonnet P, Orth G. Human papillomavirus testing in women with mild cytologic atypia. Obstet Gynecol Jun; 95 (6 Pt 1): 821 `7. 4) Manos MM, Kinney WK, Hurley LB, Sherman ME, Shieh-Ngai J, Kurman RJ, Ransley JE, Fetterman BJ, Hartinger JS, McIntosh KM, Pawlick GF, Hiatt RA. Identifying women with cervical neoplasia: using human papillomavirus DNA testing for equivocal Papani- colaou results. JAMA May 5; 281 (17): 1605 ` 10. 5) Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998; 338: 423 ` 428.

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untitled No.16 TBS TBS TBS 1 2 2 Low High 2 3 TBS ASC-USASC-H TBS TBS TBS TBS ASCASC-US,ASC-H TBS ASC ASC LSIL ASC-US HSIL ASC-H ASC 1 ASC HPV HPV TBS HPV HPV ASC-US ASC-US ASC-H ASC-US ASC-US ASC-H ASC-H