Cytopathology Terminology Systems: European Federation of Cytological Societies Survey on Practice in Europe

Cytopathologists communicate with clinicians via cytopathology reports. For decades Papanicolaou Classes (Pap Classes), descriptive reports or surgical pathology terminologies have been used. The Bethesda System for reporting cervical cytology has been the first organ-specific terminology system and since 2010, there has been a plethora of new reporting terminology systems. We aimed to map the implementation of reporting systems via a survey designed and led by the Scientific Committee of European Federation of Cytological Societies. The survey was available online between May 2022 and May 2023. For each classification, respondents were asked whether each was implemented, barriers to implementation and if there were data on national validation of the system. A total of 37 countries participated. Department-level implementation decision was the most reported (81.6%) with a strong involvement of national cytology societies. 65.8% of respondents indicated that Pap Classes were used prior to organ-specific terminologies and 60.5% of respondents used descriptive-only text prior to organ-specific terminologies. Overall half of the respondents used national or local systems (50.0%). The Bethesda System for reporting cervical cytology and the Bethesda System for reporting thyroid cytopathology have been implemented by most of the responding countries (92.1% and 94.7%, respectively). Overall, the most reported barriers to implementing terminologies were a lack of awareness of the details of the terminology (44.7%) and the difficulty in implementing the terminology (34.2%). Despite the variabilities in practices, regulations and legislations, cytopathology reporting systems are widely accepted and implemented in Europe.