The Intraepithelial Lesion: A Spectrum of Problems

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Abstract
The Bethesda System described in this week's issue ofThe Journalis an improved approach to reporting cervical/vaginal cellular abnormalities.1When abnormal, the "routine Pap smear" initiates a complex chain of events, judgments, and interactions. From a quality assurance perspective, it is necessary that each link be carefully performed if the clinical episode as a whole is to have any utility. The attending physician, cytopathologist, and the patient herself all have roles that will make or break this concatenation.2 Backed by their office managers, attending physicians have too often sought the low-price competitor with the best turnaround time. Ironically, as the price of reading and interpreting cervical cytology samples has been leveraged downward by competition for contracts, the price to the patient or payer has been pushed upward. Some physicians have become much like brokers, all too often failing to concern themselves with the necessary balance of cost

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